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CONSERVATIVE    GYNECOLOGY 

AND 

ELECTRO-THERAPEUTICS 

A  Practical  Treatise  on  the  Diseases  of  Women  and 
THEIR  Treatment  by  Electricity 

BY 

G.  BETTON  MASSEY  M.D. 

Physician  to  the  Gynecologic  Department   of  Howard  Hospital  and  Late  ELECTKo-THEKAi-EUTisT  lo 

THE  Infirmary   for   Xervous  Diseases^  Fellow  and  Ex-President  of  the  American 

Electro-Therapeutic  Association;   Member  of  the  Soci6t6  Fran- 

(JAISE    D'£lECTROTHERAPIE,    AMERICAN    MEDICAL 

Association,  etc.,  etc. 

third  edition 
revised  rewritten  and  greatly  enlarged 


Illustrated  with  Twelve  (12)  Original  Full-Page  Chromo-lithograpliic  Plates  and 

Twelve  (12)  Full-Page  Half-tone  Plates  of  Photographs  taken, 

from  Nature  and  Numerous  Engravings  in  the  Text- 


Philadelphia 

F.  A.   DAVJS  COMPANY  PUBLISHERS 

1902 


COPYRIGHT.  1398, 


THE  F.  A.  DAVIS  COMPANY. 


i  Bepif  tered  at  Stitioneic'  Hull,  London.  En§.] 


niil>ifil|iliii.  I^  U.  &  A.: 
>  Hrficil  BalletzB  PriBtisf-boBse, 
I9IC  Cherry  Street. 


PREFACE  TO  THE  THIRD  EDITR3X, 


The  exhaustion  of  the  second  edition  of  the  authors  work  on 
"Electricity  in  the  Diseases  of  Women"  necessitated  the  preparation 
of  a  third  edition  some  time  since.  In  preparing  the  material  for 
this  purpose  it  was  found  desirable  to  rewrite  and  restate  so  many 
of  the  facts  connected  with  the  application  of  electricity  to  the  dis- 
eases of  women,  in  order  that  the  Tery  latest  advances  in  this  subject 
might  be  adequately  represented,  that  an  entirely  new  book  was  the 
result,  dealing  more  fully  than  heretofore  with  the  nature  and  cau- 
sation of  the  diseases  of  women  in  which  electricity  is  urged  as  a 
rational  remedy,  as  well  as  discussing  in  full  detail  the  many  minor 
points  which  are  essential  to  success  in  its  employment. 

What  was  originally  a  mere  treatise  on  the  use  of  electricity  in 
fibroid  tumors  and  certain  other  affections  has  thus  been  transformed 
into  a  treatise  on  the  medical  and  surgical  diseases  of  women,  with 
special  reference  to  the  therapeutic  use  of  electricity.  This  broad- 
ening of  the  scope  of  the  work  has  been  made  necessary  by  the  fact 
that  nearly  all  of  the  modern  treatises  on  gynecology  have  been  written 
from  a  purely  surgical  stand-point,  leading  often  to  a  perspective  view 
of  these  affections  that  unduly  exaggerated  the  mechanical  side  of 
pelvic  pathology.  Opportunity  is  thus  afforded  for  the  rescue  from 
oblivion  of  certain  neglected  facts  as  to  the  origin  and  nature  of 
inflammatory  diseases  of  the  uterus  and  adnexa,  and  for  the  fuller 
consideration  of  the  neural  disorders  most  frequently  found  among 
women,  while  special  attention  is  accorded  to  fibroid  tumors  and 
their  treatment  by  the  Apostoli  method,  and  to  the  authors  method 
for  the  treatment  of  cancer. 

As  a  treatise  on  the  diseases  of  women  no  claim  is  made  that 
it  covers  the  field  so  ably  occupied  by  the  works  on  abdominal  and 
pelvic  surgery  alluded  to.  but  only  that  it  covers  ground  of  more 
value  to  the  average  physician  and  his  patients  than  books  devoted 
to  the  details  of  operations  that,  however  necessary  at  times,  are  oft-en 
only  properly  of  service  as  last  resorts,  and  are  then  incapable  of' 
application  except  at  hands  that  have  had  more  than  a  book-training. 

(iii) 


IV  PREFACE    TO    THE    TUJKD    EDITION. 

Besides,  iu  the  present  redundant  condition  of  tiie  physician's  book- 
shelves, no  author  has  a  right  to  burden  liis  readers  with  attempts 
at  compreliensiveness  which  transcend  the  immediate  bounds  of  liis 
personal  experience,  and  when  he  confines  himself  to  that  experience 
and  its  teachings  he  has  fully  discharged  his  duty  both  to  his  readers 
and  to  science,  without  implying  that  the  experience  of  others  is  not 
also"  of  value. 

With  all  modesty,  therefore,  but  with  a  lively  appreciation  of 
the  importance  of  the  facts  and  methods  herein  detailed  in  enabling 
the  progressive  physician  to  save  his  patients  from  the  dangers  of 
both  neglect  and  of  misapplied  methods  of  treatment,  the  author 
commends  this  work  to  his  professional  brethren  and  bespeaks  for  it 
a  share  of  attention  and  kind  consideration  at  least  as  great  as  that 
accorded  to  each  of  its  predecessors. 

Thanks  are  due  to  Mr.  Xanthus  Smith,  the  well-known  artist, 
for  the  accuracy  of  the  illustrations  that  appear  here  for  the  first  time. 
•  Instead  of  reprqdueing  the  now  classical  drawings  of  the  motor 
points  of  the  nerves  and  muscles,  it  was  thought  best  to  secure  greater 
accuracy  by  verifying  each  point  on  the  person  of  a  professional  model 
and  then  photogj-aphing  the  living  subject.  Plates  VIII  and  IX  are, 
therefore,  half-tone  reproductions  of  actual  photographs,  and  it  is 
hoped  that  this  method  of  depicting  the  real  situation  of  these  points 
will  lead  to  greater  ease  in  their  location  than  has  been  the  case  in 
the  past.  The  services  of  a  professional  model  were  also  invoked  in 
the  more  realistic  delineation  of  the  therapeutic  procedures  shown  in 
Plates  III  to  VII. 

In  preparing  the  series  of  colored  plates  showing  the  appearance 
of  the  cervix  and  uterine  discharges  in  typical  cases  of  disease,  in 
which  Mr.  Smith  was  engaged  in  pioneer  work  in  medical  illustration, 
special  thanks  are  due  to  Drs.  J.  Montgomery  Baldy,  W.  A.  Newman 
Borland,  Frank  W.  Talley,  Theodore  A.  Erck,  Oliver  Hopkinson, 
and  Carrie  Chase  Davis  for  facilities  afforded  in  securing  the  typical 
cases  from  which  sketches  were  made. 

1636  WaI-NUT  RtuEET,  PHIT-ADEM'HIA. 

.June,  18!)8. 


CONTENTS. 


PART  I. 

CHAPTER  I. 

PAGE 

The  Nature  and  Predisposing  Causes  of  the  More  Common  Affec- 
tions OF  Woman,      .        .        .        ...        .        .        .        .        .1 

Developmental  Faults  of  Early  Womanhood.  Disordere  of  Maturer 
Womanhood. 

CHAPTER  II. 

On   the  Examination  of  Cases  with  Reference  to  the  Propriety 

OF  Employing  Conservative  Methods  of  Treatment,     .        .      9 

General  Examination  and  Classification  of  Cases.  Examination  of  Abdo- 
men. Examination  of  Pelvis.  Aspiration.  Aseptic  Precautions  in 
Routine  Gjaiecic  Practice  and  Electro-gynecology. 

CHAPTER  III. 
Introductory  Remarks  on  Electricity  as  a  Remedy  in  Gy'necology',     24 

How  Electricity  Becomes  a  Remedy.  Special  Value  of  Electricity  in 
Gynecology.  Special  Vahie  of  Electro-gynecic  Applications  to  the 
General  Practitioner.     Limitations. 

CHAPTER  IV. 

Phenojiena    Attending   the   Transmission    of    Galvanic    Currents 

Through  Living  Organs, 31 

Physical  Reasons  for  Electrode  Coverings.  Current-diffusion  Within  the 
Body.  Current-concentration.  Polar  Regions.  The  Interpolar  Re- 
gion. Electrolysis.  Cataphoresis.  Functional  Stimulation  and  Se- 
dation. Bactericidal  Action  of  Electricity.  The  Alterative  Action 
of  Electricity.  Indications  for  Choice  of  Poles.  Interrupted  Gal- 
vanic Currents  in  Gynecology.  Differences  Between  the  Currents 
Used  in  Medicine. 

CHAPTER  V. 

Typical  Methods  of  Applying  Electric  Currents  in  the  Diseases 

OF  Women, 53 

General  Galvanic  Stimulation.  General  Farmlic  Stinuilation.  Abdomino- 
Dorsal  Applications.  Spinal  Applications.  Vaginal  Galvanic  Appli- 
cations. Vaginal  Faradic  Applications.  Intra-uterine  Galvanic  Ap- 
plications.    Intra-iiterine  Faradic  Applications. 

(V)     . 


VI  CONTENTS. 

CHAPTER  VI. 

PAGE 

ADDiTrox.4L  Systematic  Methods  in  Gynecic  Practice,        .        .        .67 

Posture.  Hydrothernial  Applications  to  the  Pelvis.  Vaginal  Swabbing. 
Tampons.     Pessaries.     Massage. 

CHAPTER  VII. 
Menstrual  Deraxgesients, 72 

Amenorrhea.  Scanty  Menstruation.  Menonhalgia.  Menorrhagia  and 
Metrorrhagia. 

CHAPTER  VIII. 

Catarrhal    Affections    of    the    Utero-Tubal    Mucous    Tract    and 

Their  Consequences, 86 

The  Etiologic  Unity  of  Uterine  and  Tubal  Catarrh.  The  Therapeutic 
Problem.  Diagnostic  Value  of  Inspection  of  Persistent  Uterine  Dis- 
charges. Cervical  I^ndometritis.  Corporeal  Endometritis.  Chronic 
Metritis.  Post -puerperal  Metritis  ;  Neglected  Subinvolution.  Hem- 
orrhagic Metritis.  Hyperplasia  of  the  Uterus,  with  or  without  Cer- 
vical Laceration.  Senile  or  Atrophic  Metritis.  Metrosalpingitis. 
Purulent  Salpingitis.  Pyosalpinx.  Hematosalpinx.  Hydrosalpinx. 
Pelvic  Peritonitis. 

CHAPTER  IX. 
Chronic  Inflammatory  Affections  of  the  Ovaries,  .  .114 

Chronic  Ovaritis.     Ovarian  Congestion. 

CHAPTER  X. 

Fibroid  Tumors, 121 

Origin.  Clinical  Varieties.  Natural  Prognosis  of  Fibroid  Tumors  With- 
out Treatment.  Apostoli's  Discover}'.  Mode  of  Action  of  Elec- 
tricity. Selection  of  Suitable  Cavses.  Contra-indications.  Methotls. 
Results  of  Treatment  by  Electricity. 

CHAPTER   XI. 

Displacements  a.vd  Non-tkaumatic  Relaxations  of  the  Pelvic  Vis- 
cera,   183 

The  Author's  Method.     Tripier's  McIIkmI. 

CHAPTER  XII. 

Relaxation   and  Finctional  Incapacity  of  the  .\hdominal  Walls 

AND  Viscera, 191 

CH.XPTER  XIII. 

The  Border-line  Between  Gynecolooy  and  Neurology,  .197 

The  Rest  Cure  in  the  Treatment  of  Hysteria  and  Hysteroid  Affections. 


CONTENTS.  Vll 

CHAPTER  XIV. 

PAGE 

Neurasthenia  and  Nervous  Prostration, 204 

CHAPTER  XV. 
Institutional  Treatment, 209 

CHAPTER  XVI. 
Maternal  Sterility  and  Impotence, 212 

CHAPTER  XVII. 

Ectopic  Gestation  and  Obstetrics, 215 

Ectopic  Gestation.  Abortion.  Hyperemesis  Gravidarum.  Use  of  the 
Faradic  Current  in  Labor.  Inertia  Uteri.  Post-partum  Hemorrhage. 
Recent   Subinvolution. 

CHAPTER  XVIII. 
Malignant  Growths, 231 

Inglis-Parsons's  Method  in  Epithelioma  of  the  Portio  Vaginalis.  Author's 
Method  of  Mercuric  Cataphoresis  as  a  Cure  for  Cancer.  Details  of 
the  Author's  Major  Method.  Details  of  the  Author's  Minor  Method. 
Technique  of  the  Author's  Method  for  Carcinoma  of  the  Portio  Vagi- 
nalis. 

CHAPTER  XIX. 
Benign  Tumors  of  the  Breast, 256 

CHAPTER  XX. 

Diseases  of  the  Urethra,  Bladder,  Rectum,  and  Sigmoid  Flexure,  258 

Caruncle.  Stricture  or  Ulcerations  of  the  Urethra.  Neuroses  of  the  Ure- 
thra and  Vulva.  Atony  of  the  Bladder.  Cystoscopy.  Anal  Fissure. 
Hemorrhoids.  Prolapse  of  the  Rectum.  Stricture  of  the  Rectum. 
Ulcerations  and  Adenoids  of  the  Rectum . 

CHAPTER  XXI. 
The  Cosmetic  Applications  of  Electricity, 273 

Superfluous  Hair.  Moles  and  Warts.  Nevus  Vasculosus  (Port-wine 
Mark).     Nevus  Pigmentosus. 


PART  II.— RUDIMENTS  OF  MEDICAL  ELECTRICITY. 

CHAPTER  XXII. 

Physics  of  the  Galvanic,  or  Direct,  Current, 277 

Electromotive  Force  (Pressure).  Resistance.  Units  of  Current.  Inter- 
nal Resistance  of  Cells  and  Batteries.  Application  of  Ohm's  Law  to 
the  Arrane-ement  of  Cells. 


VIU  CONTENTS. 

CHAPTER  XXIII. 

PAGE 

The  Production  and  Control  of  Galvanic  Currents,  .        .        .  290 

The  Incandescent  Circuit.  Stationary  Battery  of  Cells.  Portable  Bat- 
teries. The  Current-controller. "  The  Meter.  Electrotles.  Office 
Switchboards. 

CHAPTER  XXIV. 

Experimental  Handling  of  Galvanic  Currents, 312 

To  Test  for  Current.  (Experiment  2).  To  Test  the  Power  of  the  Bat- 
tery and  the  Range  of  the  Controller.  (Experiment  3).  To  Test 
the  Polarity  of  the  Electrodes.  (Experiment  4).  Comparison  of 
Metallic  Contact  with  Moist  Cotton  to  Cotton  Conduction.  (Experi- 
ment 5).  Application  of  Dry  ^Metallic  Electrodes  to  Skin  Compared 
with  that  of  Wet  Electrodes.  (Experiment  6).  Effect  Produce<l  on 
the  Current-volume  bj- Salt  "Water  on  the  Electrodes.  (Experiment 
7).  Effect  upon  the  Current  of  Different-Sized  Electrodes.  (Experi- 
ments). Comparison  of  the  Effect  of  the  Same  Current-strength  when 
Concentrated  and  Diffused.  (Experiment  9).  Differing  Resistances 
of  Skin  Surfaces.  (Experiment  10).  Comparison  of  the  Resistance 
of  Skin  and  Mucous  IMembrane.  (Experiment  11).  Alteration  of 
Nerve-irritability  Within  each  Polar  Region.  (Experiment  12). 
The  Effect  on  Nerves  of  a  Slowly-  Varied  or  Continuous  Current  Com- 
pared with  that  of  a  Sudden  Current-variation.     (Experiment  13). 

CHAPTER  XXV. 
The  Faradic  Current, 318 

Mode  in  which  Faratlic  Currents  are  Produced.  Means  of  Controlling 
Faradic  Currents.  The  Cell  and  Cell-current.  The  Primary  Coil  and 
Core.  Primary  Current.  The  Secondary  Coil  and  Current.  The  In- 
terrupter, or  Rheotome.  Polarity  of  the  Faradic  Current.  Indica- 
tions for  the  Use  of  Covered  and  Bare  Electrodes  with  Faradic  Cur- 
rents. Experimental  Comparison  of  the  Electromotive  Force,  or 
"Pressure,"  of  the  Faradic  Cunent  with  that  of  the  Galvanic  Cur- 
rent. (Experiment  14).  Action  of  the  Faradic  Current  on  Sensory 
Nerves  and  JIuscles.     Therapeutic  Uses.     Electrodes  and  Dosage. 

CHAPTER  XXVI. 
Franklinic,  or  Static,  Electricity, 332 

Physics.  Selection  and  Care  of  the  Static  Machine.  Methotis  of  Applica- 
tion. After  Using  the  Machine.  Therapeutic  Uses  in  Gynecology. 
Production  of  Roentgen  Rays  ))y  the  Static  Machine. 

CHAPTER  XX VII. 
The  Sinusoidal  and  Incandescent  Alternating  Currents,  .  346 

The  Sinusoidal  Current.     The  Incandescent  Alternating  Current. 

CHAPTER  XXVIII. 
Electric  Light  as  an  Illu.minant  and  as  a  Therapeutic  Agent,     .  353 

Direct  Illumination  of  the  Vagina.  Transillumination  of  the  Pelvis. 
Electric  Light  as  a  Therapeutic  Agent. 


CONTENTS.  IX 

APPENDIX  A. 

PAGE 

Table  of  Eighty-six  Consecutive  Cases  of  Fibromata,  with  Details 

OF  Treatment  and  Ultimate  Results, 363 

APPENDIX  B. 

Table  of  Thirty-four  Consecutive  Cases  of  Catarrhal  Disease  of 

Uterus  Under  Electric  Treatment,   .         .        .        .        .        .  383 

Index, 389 


LIST  OF  ILLUSTRATIONS. 


FIG.  PAGE 

1.  Dorsal  position.     (Drawn  from  photograph  of  model.) 12 

2.  Diagram  of  abdominal  regions,  showing  position  of  viscera.     (After  Gray.)  .  13 

3.  Bimanual  abdominal  palpation.     (Drawn  from  model.) 14 

4.  Abdominal  relaxation,  as  shown  in  the  erect  position 15 

5.  Goodell  speculum,  latest  pattern 16 

6.  Bimanual  pelvic  examination 17 

7.  Simpson's  sound. 17 

8.  Method  of  inserting  sound  by  touch.     The  finger  is  shown  behind  the  cervix.  18 

9.  Sims's  position.     (Fi'om  photograph  of  model.) 19 

10.  Sims's  speculum. 20 

11.  Attitude  of  nurse  in  Sims's  position.     (Di-awn  from  photograph  of  model.)   .  21 

12.  Aspirator 22 

13.  Applying  absorbent  cotton  to  electrode  disk  (first  stage) 32 

14.  Applying  absorbent  cotton  to  electrode  disk  (second  stage) 32 

15.  Diagram  showing  the  distribution  of  a  current  of  twenty  volts  within  a  nar- 

row conductor 34 

16.  Distribution  of  a  currcTit  of  twenty  volts  within  a  wider  conductor.        .         .  34 

17.  Distribution  of  a  current  of  twenty  volts  within  the  human  body.  ...  35 

18.  Diagram  of  polar  and  interpolar  regions.  ........  37 

19.  Diagram  of  electrolysis 39 

20.  Apparatus  employed  by  Apostoli  for  testing  the  bactericidal  action  of  elec- 

tricity   49 

21.  Author's  cotton-covered  vaginal  electrode.         . 57 

22.  Goelet'a  bipolar  vaginal  electrode 59 

23.  Apostoli's  intra-uterine  electrode 60 

24.  Author's  sound-shaped  platinum  intrauterine  electrode  with  fusible  covering 

of  shellac 61 

25.  Author's  spiral  elastic  intra-uterine  electrode  of  platinum 62 

26.  Set  of  zinc  intra-uterine  electrodes  for  mercuric  cataphoresis.         .         .         .63 

27.  Apostoli  bipolar  intra-uterine  electrode  with  fusible,  aseptic  covering.    .         .  66 

28.  Knee-chest  position.     (Drawn  from  photograph  of  model.)      ....  67 

29.  Section  of  uterus  made  at  OS  internum.     (Barnes.) 76 

29a.  Goelet's  platinum  cannula-electrode 109 

30.  Line  of  rigidity  in  pelvic  peritonitis.     (Thomas  and  Mund6.)           .         .         .  112 

31.  Intramural  fibroid  tumor.     (Drawn  from  specimen  in  the  Miitter  Museum  of 

the  College  of  Physicians.) 122 

32.  Submucous   and    intramural    fibroid    tumors.       (Drawn    from    specimen    in 

the  Miitter  Museum  of  the  College  of  Physicians.) 123 

33.  Multinodular  fibroid  with  submucous  projections.     (Drawn  from  specimen  in 

the  Miitter  Museum  of  the  College  of  Physicians.)              ....  124 

(xi) 


Xll  LIST    OF    ILLUSTRATIONS. 

FIG.  PAGE 

34.  Fibroid  polypus 125 

35.  Subperitoneal  fibroid  with  sessile  attachment  to  posterior  wall  of  utei'us. 

(From  specimen  in  the  Mutter  Museum  of  the  College  of  Ph3'sicians.)      .  126 

36.  Pedunculated  subperitoneal  fibroid.     (From  specimen  in  the  Miitter  Museum 

of  the  College  of  Phj-sicians.) 127 

37.  Multinuclear  interstitial  fibroid  with  one  nodule  aflected  by  calcareous  degen- 

eration.    (From  specimen  in  the  Miitter  Museum  of  the  College  of  Phy- 
sicians.)            128 

38.  Apostoli's  vaginal  puncture  trocar,  for  use  with  handle  shown  in  Fig.  23.       .  136 

39.  Author's  vaginal  puncture  trocar  (enlarged  sectional  view) 136 

40.  Author's  abdominal  puncture  needle  (shown  in  enlarged  section).  .  .  139 

41.  Diagram  of  original  outline  of  tumor  in  Case  1 144 

42.  Diagram  of  oi'iginal  outline  of  tumor  in  Case  5.       .....         .  145 

43.  Diagram  of  original  outline  of  Case  6.        .         . 146 

44.  Diagram  of  oiiginal  outline  of  Case  7.       .         .         .  ....  147 

45.  Diagram  of  original  outline  of  Case  13.     ........  149 

46.  Diagram  of  oiiginal  outline  of  Case  17 1.50 

47.  Original  outline  of  tumor  in  Case  35. 152 

48.  Outline  of  tumor  in  Case  35  after  treatment. 153 

49.  Original  outline  of  tumor  in  Case  38. 1.54 

.50.  Outline  of  uterus  in  Case  38  after  treatment.     .......  155 

51.  Outlines  of  tumor  in  Case  46  at  various  dates 156 

52.  Original  outline  of  tumor  in  Case  61,  showing  method  of  treatment.       .         .  158 

53.  Outline  of  Case  61  after  treatment •  .         .         .         .159 

.54.  Outline  of  tumor  in  Case  1  of  Dr.  Ilaultain's  before  treatment.     (Haultain.)  174 

55.  Case  1  after  treatment.     (Haultain.) 175 

56.  Outline  of  tumor  in  Case  2  of  Dr.  Haultain's  before  treatment.     (Haultain.)  176 

.57.  Case  2  after  treatment.     (Haultain.) 177 

5S.  Sectional  view  of  a  case  of  hypertrophy  and  piolupse  of  the  infravaginal  cervix.  188 

59,  60,  and  61.  Tripier's  rectal,  uterine,  and  vesical  electrodes  for  displacements.  190 

62.  Tripier's  faradic  method  for  anteflexion 191 

63.  Tripier's  method  of  faradic  treatment  for  retroflexion 192 

64.  GaiflTe  pocket  faradic  battery 228 

65.  The  Massey  transpoitable  galvanic  battery .  238 

66.  The  author's  gold  and  zinc  puncture  electrodes 341 

67.  Hollow,  bulbous  electrode  of  gold  for  dissemination  of  mercury  in  cavities.   .  242 

68.  Arrangement  of  apparatus  and  patient  in  the  cataphoric  treatment  of  cancer.  243 

69.  Outlines  of  circumference  of  sarcoma  in  Dr.  McFadden  Gaston's  case.    .         .  2-52 

70.  Double,  bipolar  instrument  for  electrolytic  destruction  within  a  cavity.  .         .  254 

71.  Cystoscope  of  J.  Howard  Kelly. ~62 

72.  Urethral  calibrator. 263 

73.  Kelly's  urethral  dilator 264 

74.  Cystoscopic  syringe 265 

75.  Uieteral  searcher 266 

76.  Author's  hemorrhoidal  needle  electrode 270 

77.  Diagrammatic  representation  of  the  cause  of  flow  in  hydraulic  currents.        .  278 

78.  Diagrammatic  representation  of  the  cause  of  flow  In  electric  currents.    .         .  279 

79.  Diagram  of  direction  of  current  within  a  cell 280 

80.  Diagram  showing  analogy  of  laws  governing  pressure  in  pumj)  and  dynamo 

circuits.                    281 


LIST    OF    ILLUSTRATIONS.  XUi 

FIG.  '  PAGE 

81.  Three  cells  connected  "in  scries." 284 

83.  Three  cells  connected  "  for  surface,"  or  in  parallel  arc 28.5 

S3.  Graphic  delineation  of  the  pressure  and  volumes  of  currents  from  a  single 

galvanic  cell.          . 286 

84.  Graphic  delineation  of  the  pressure  and  volumes  of  currents  from  a  battery 

of  twenty  cells  arranged  "  for  surface." 287 

8.5.  Gi'aphic  delineation  of  the  pressure  and  volumes  of  currents  from  a  battery 

of  twenty  cells  arranged  "in  series." 288 

86.  Diagram  of  circuit  arrangement  for  using  incandescent  current.      .         .         .  291 

87.  Author's  switchboard  for  obtaining  the  galvanic  current  from  the  Edison  in- 

candescent mains 292 

88.  Geiger  shunt-controller,  or  volt-selector 29.3 

89.  Improved  Massey  current-controller 294 

90.  Jewell  graphite  controller. 294 

91.  Arrangement  of  circuit  for  Jewell  controller 295 

92.  Mcintosh  switchboard  for  galvanic  and  faradic  currents.          ....  296 

93.  Carbon  cylinder  cell 297 

94.  Elements  of  carbon  cylinder  cell 298 

95.  Flemming  portable  galvanic  battery  with  meter  and  controller  attached.        .  299 

96.  Insertion  of  meter  and  controller  in  circuit  of  ordinary   portable  galvanic 

battery .300 

97.  Mcintosh  twenty-four-cell  portable  galvanic  battery 301 

98.  The  Kidder  portable  galvanic  battery,  showing  top-plate  and  elements.  .         .  302 

99.  Skeleton  drawing  of  Waite  &  Bartlett  thirty-cell  galvanic  battery.       .         .  304 

100.  Massey  current-controller. 305 

101.  Weston  milliammeter,  arranged  specially  for  medical  work 307 

102.  Jacketed  pan  for  clay  pads 308 

103.  Author's  wired-cotton  electrode  pads 309 

104.  Author's  complete  switchboard  arrangement  for  both  currents.        .         .         .  310 

105.  Diagram  of  faradic  batteiy 319 

106.  Flemming's  No.  4  faradic  battery 322 

107.  Mcintosh  faradic  battery 323 

108.  End-view  of  Rockwell's  high-tension  coil. 824 

109.  Engelmann's  faradic  battery 325 

110.  De  Watteville  combiner 327 

111.  Type  of  the  Waite  &  Bartlett  and  Van  Houten  ifc  Ten  Broeck  multiple  plate 

static  machines, 334 

112.  Electrodes  for  use  with  static  mchine 337 

113.  Arrangement  of  circuit  for  Morton's  static  induced  current 341 

114.  Queen  self-regulating  x-ray  tube 343 

115.  Arrangement  of  static  machine  for  the  production  of  Roentgen  ra}-s.      .         .  345 

116.  The  Kellogg  sinusoidal  apparatus .346 

117.  Graphic  representation  of  the  sinusoidal  current  in  Dr.  Kellogg's  apparatus. 

(Kellogg.) 347 

lis.  Sinusoidal  curve  obtained  by  d'-\rsonval 347 

119.  Current  from  faradic  apparatus.     (Kellogg.) 347 

120.  Current  from  faradic  apparatus.     (Kellogg.) 347 

121.  Representation   of   magneto-electric    current   not    sinusoidal   in    character. 

(Kellogg.) 348 


XIV  LIST   OF    ILLUSTRATIONS. 

FIG.  PAGE 

122.  Current  from  du  Bois-Reymoiid  coil.     (Kellogg.) 348 

123.  Characteristic  marking  of  the  rapidly-successive  inductions  of  a  poor  faradic 

coil.     (Kellogg.) 348 

124.  Current  from  coil  excited  by  Thompson-Houston  arc  light,  alternating  16,800 

times  per  minute.     (Kellogg.) 348 

125.  Mcintosh  sinusoidal  apparatus,  with  motor 349 

126.  Kenuelly  sinusoidal  apparatus  and  motor. 3.50 

127.  Shaw"s  acid  carbon  cell,  of  large  size,  for  running  motors,  lighting  small 

lamps,  etc 351 

128.  Sajous's  lamp-holder  and  stand. 353 

129.  Isaac's  search-light 354 

130.  Phillips's  electric  head-light  for  four-  or  six-  volt  lamp.    .....  3.55 

131.  Author's  pelvic  transilluininator 356 

132.  Apparatus  of  Chevalier  Jackson  as  arranged  for  transillumination  of  the 

nasal  passages  and  antrum .  357 

133.  Alternating  current-transformer  of  Williams,  Brown  &  Earle.         .         .  358 

134.  Controller  for  lighting  small  lamps  and  heating  cautery  loops  from  Edison 

current 358 

1.35.  The  Kellogg  electric-light-bath  cabinet 359 

136.  The  electrotherm 360 


LIST  OF  FULL-PAGE  PLATES. 


PAGE 

Plate  I. — Arrangement  of  examining  chair  and  apparatus.  .         .         .        Facing  52 

Plate  II. — Arrangement  of  applying  couch  and  apparatus.  .         .         .         Facing  .52 
Plate  III. — Application  to   arm,  general  galvanic  stimulation.     (Photographed 

from  professional  model.) Facing  54 

Plate  IV. — Application  to  leg,  general  galvanic   stimulation.     (Photographed 

from  professional  model.) Facing  54 

Plate  V. — Application  to  abdomen,  general  galvanic  stimulation.  (Photographed 

from  professional  model.) Facing  54 

Plate  VI. — Stabile  faradic  application  to  abdomen,  general  galvanic  stimulation. 

(Photographed  from  professional  model.)          .         .         Facing  .54 
Plate  VII. — Dorso-abdominal  application,  general  galvanic  stimulation.    (Photo- 
graphed from  professional  model.)      ....         Facing  54 
Plate  VIII. — Motor  points  of  anterior  portion  of  bod}'.     (Photographed  from  pro- 
fessional model.) Facing  .54 

Plate  IX. — Motor  points  of  posterior  portion  of  body.     (Photographed  from  pro- 
fessional model.) Facing  .54 

Plate  X. — Chronic  leucorrhea  of  vaginal  origin Facing  90 

Plate  XI. — Chronic  purulent  leucorrhea  of  uterine  origin.  .         .         .         Facing  90 

Plate  XII. — Erosion  of  cervix  with  slight  laceration Facing  90 

Plate  XIII. — Erosion  of  cervix Facing  90 

Plate  XIV. — Cervical  endometritis  (early  stage) Facing  90 

Plate  XV. — Cervical  endometritis  (late  stage) Facing  90 

Plate  XVI. — Gonorrheal  endometritis  (early  stage).      ....        Facing  90 

Plate  XVII. — Corporeal  endometritis  of  septic  origin.                   .         .         Facing  90 
Plate   XVIII. — Purulent  leucorrhea  in   metrosalpingitis  of  gonorrheal   origin. 

Facing  90 
Plate  XIX. — Traumatic  relaxation  of  the  pelvic  outlet  with  cystocele  and  recto- 

cele Facing  188 

Plate  XX. — Hypertrophy  and  prolapse  of  the   infravaginal  cervix  in  a  yoiing 

negress Facing  188 

Plate  XXI. — Carcinoma  of  the  cervix  uteri Facing  252 

Plate  XXII. — Application  of  head-spray Facing  338 

Plate  XXIII. — Application  of  direct  sparks  by  roller  electrode.    .                 Facing  338 

Plate  XXIV. — Indirect  sparks  (condensers  should  be  removed).           .         Facing  340 

(XV) 


PART   I. 


CHAPTEK  I. 

The  Natuee  and  Peedisposing  Causes  of  the  Moee 
Common  Affections  of  Woman. 

Developmental  Faults  of  Early  Womanhood. — The  girl  is  the 
antetype  of  the  woman  in  physical  as  well  as  mental  endowment; 
hence  the  prophecy  of  a  wholesome  maturity,  or  the  seeds  of  many  of 
the  physical  and  neural  ills  of  womanhood,  may  be  traced  in  the 
heredity  received  plus  the  environment  of  her  developmental  stage. 
Under  the  unrestrained  operation  of  the  laws  that  govern  evolution 
the  all-pervasive  influences  of  an  awakening  womanhood  tend  toward 
the  more  perfect  establishment  of  its  character  in  the  individual,  and 
would  doubtless,  in  later  generations,  produce  women  of  increasing 
womanliness,  physically  and  mentally;  for  natural  selection  between 
the  sexes  is  apt  to  be  governed  by  inherently  correct  mutual  attrac- 
tions. The  conditions  of  civilization  and  the  demands  of  society, 
however,  do  much  to  nullify  rather  than  increase  such  wholesome 
tendencies,  and  the  result  of  marriages  as  usually  contracted  is  often 
the  production  of  stationary  or  atavistic  progeny. 

Under  the  operation  of  umvise  or  accidental  sexual  selection  we 
may  have,  therefore,  the  descent  of  an  acquired  heredity  of  physical 
weakness  or  emotional  impressionability, — conditions  which,  if  asso- 
ciated with  a  non-corrective  environment,  are  sure  to  result  in  disaster 
to  the  life-history  of  the  individual.  In  heredity  we  have,  conse- 
quently, a  most  potent  cause  for  the  developmental  faults  of  early 
womanhood. 

The  influence  of  environment  either  in  perfection  or  correction 
of  girlish  character  is  peculiarly  powerful  in  her  stage  of  development, 
for,  contrasted  with  that  of  man,  this  stage  of  development  involves 

(1) 


2  DISEASES    OF    WOMEN. 

phenomena  of  a  far  greater  relative  importance,  the  physical  and 
mental  phenomena  that  bear  a  direct  relation  to  sexual  characteristics 
impressing  every  fibre  of  her  being,  her  emotions,  and  her  judgment. 
Nature  has,  herself,  therefore,  made  the  hygienic  path  of  girls  nar- 
rower than  that  of  boys,  for,  in  endowing  them  with  the  susceptibili- 
ties of  highly  specialized  functions,  it  has  furnished  another  predis- 
posing cause  for  disease,  in  the  shape  of  a  special  vulnerability  to 
unfavorable  environment. 

Since  heredity  is  beyond  the  control  of  living  beings  (and  society 
even  yet  refuses  to  apply  well-known  rules  of  scientific  breeding  to 
its  unborn  children),  it  is  to  the  correction  of  environment  that  both 
parents  and  physicians  must  look  for  reparative  effects,  and  it  is  fort- 
unate that  environment  may  be,  at  times,  as  effective  in  producing 
results  as  heredity  itself. 

In  the  scientifically-bad  environment  we  have  the  second,  but 
most  practically  important,  cause  of  developmental  faults  in  young 
girls.  Striking  portions  of  this  are:  influences  which  cultivate  selfish- 
ness and  neglect  inculcation  of  that  wholesome  instinct  of  self-sacri- 
fice in  little  matters  which  does  so  much  to  ennoble  womanly  char- 
acter; influences  which  favor  introspection  as  to  bodily  ills  and  cause 
undue  attention  to  be  paid  to  little  aches  and  pains  that  would  be 
forgotten  were  more  attention  paid  to  active  duties  and  pleasures; 
lack  of  earnest  occupation  for  body  and  mind;  lack  of  out-door  life; 
mental  cramming,  with  neglect  of  physical  education  in  schools; 
neglected  excretions;  unhygienic  dress. 

It  is  well-known  that  hysteria  is  rarely  or  never  found  except  in 
girls  who  have,  at  some  time,  suffered  from  that  unfortunate  mental 
discipline  known  as  "spoiling";  but  it  is  not  so  well  appreciated  that 
its  earliest  evidences  may  be  traced  in  the  habit  of  selfishness  and 
self-indulgence  in  little  things,  and  that  this  habit  long  fostered  re- 
quires but  little  else  to  produce  the  disease.  Of  lack  of  mental  occu- 
pation it  may  be  remarked,  in  passing,  that  there  are  but  two  attitudes 
toward  the  problems  of  her  immediate  future  that  are  mentally 
healthy  for  young  girls:  they  must  either  cultivate  society  and  a 
natural  interest  in  the  young  members  of  the  opposite  sex  among 
their  acquaintances,  or  they  must  devote  unflagging  energies  to  some 
real  pursuit  or  occupation.  It  is  the  more  retiring  and  prudish  girls 
who,  while  neglecting  the  career  of  a  social  favorite,  and  failing  to 
replace  its  mind-absorbing  duties  and  pleasures  by  an  equally  absorb- 


NATURE    AND    PREDISPOSING    CAUSES.  3 

ing  career  or  occupation,  fall  early  victims  to  neurasthenia  and  other 
nervous  troubles. 

Some  of  the  instances  of  bad  environment  enumerated  are  fort- 
unately fast  disappearing,  but  many  of  them  are  still  most  conspicu- 
ous and  active  enemies  of  womanly  health  and  perfection.  The 
hygienist  of  to-day  has  much  to  be  thankful  for  in  the  changing  con- 
ditions governing  the  lives  of  intelligent  girls  and  women,  thanks  to 
the  somewhat  recent  elevation  of  health  and  vigor  into  an  idol  of 
fashion.  Protests  are  still  made  against  waist-borne  clothing,  it  is 
true;  but  much  of  this  is  hypercritical,  for  it  cannot  be  easily  demon- 
trated  that  the  shoulders,  suspended  from  the  chest  as  they  are  by 
mere  muscular  and  ligamentous  attachments,  are  better  adapted  to 
support  clothing  than  a  bony  prominence,  such  as  the  hip,  which  is 
superposed  directly  on  the  bony  structures  of  the  thigh  and  leg.  The 
question  is  entirely  apart  from  that  of  tight  lacing,  than  which  noth- 
ing could  be  more  injurious  to  the  organs  of  the  abdomen  and  pelvis. 
That  our  grandmothers  could  have  existed  within  their  "stays"  is  but 
an  evidence  of  physiologic  endurance.  Their  grand-daughters  are 
more  sensible;  yet  the  physician,  and  the  artist  also,  must  still  bewail 
a  fashion  that  not  only  constricts  the  waist  to  an  improper  degree, 
with  consequent  displacement  of  internal  organs,  but  destroys  the 
vigor,  pliancy,  and  independent  activities  of  the  abdominal  and  dorsal 
muscles,  resulting  in  weak  backs,  Aveak  abdomens,  and  palpable  dis- 
tortion of  the  abdominal  contours. 

Besides  inculcating  the  preventive  measures  naturally  indicated 
by  the  mere  suggestion  of  such  and  kindred  faults  of  environment, 
the  physician  should  not  hesitate  to  welcome  and  advise  the  sensible 
use  of  the  bicycle  by  young  girls,  under  the  important  conditions  of 
an  anatomically  correct  saddle,  an  upright  position  on  the  wheel,  and 
proper  moderation  in  its  use.  With  these  conditions  secured,  one  can 
be  certain  that  a  valuable  h5^gienic  measure  has  been  attained  which 
will  not  only  prevent,  but  even  cure,  maldevelopment  of  the  secondary 
puberty,  when  so  many  of  the  disorders  of  young  womanhood  arise. 

Among  the  most  serious  maldevelopments  of  young  girls  is  an 
imperfect  evolution  of  the  menstrual  function  in  which  this  evidence 
of  maturity  is  attended  with  undue  pain.  This  subject  is  fully  con- 
sidered in  the  appropriate  chapter;  but  in  this  summary  of  the  under- 
lying causes  of  the  affections  peculiar  to  women  it  is  proper  to  note 
that  the  author  regards  these  conditions  as  strictly  neural  or  inflam- 


4  DISEASES    OF    WOMEN. 

matory,  or  a  combination  of  both,  and  that  his  experience  has  enforced 
the  conclusion  that  the  mechanical-obstruction  theory  of  menstrual 
pain  is  a  wide-spread  delusion  and  totally  unsupported  by  the  facts. 
No  damming  up  has  ever  been  observed  in  these  cases,  nor  has  it 
been  proven  that  the  narrow  or  tortuous  uterine  canal  is  not  still 
capable  of  giving  exit  to  the  menstrual  fluid  supposed  to  be  held  back 
by  it.  Until  actual  obstruction  can  be  proven  it  is  evident  that  the 
elaborate  operations  of  slitting  up  or  dilating  the  cervix  are  illogical 
and  harmful,  the  few  instances  in  which  it  has  apparently  been  of 
service  in  allaying  pain  being  equally  explainable  on  the  theory  of 
this  effect  being  actually  due  to  the  cure  of  the  hyperesthesia.  It  is 
evident,  on  the  contrary,  that  the  pain,  as  a  rule,  precedes  the  flow, 
and,  in  the  absence  of  an  expansion  of  the  uterine  cavity  above  the 
internal  os,  it  is  clear  that  it  precedes  the  actual  secretion  of  the  fluid 
itself. 

Common  sense  alone  would  indicate,  therefore,  that  undue  men- 
strual pain  is  a  reaction  between  vasomotor  conditions  within  the 
affected  organs  and  their  nerve-centres,  the  remote  causes  being  either 
a  bad  local  or  general  nutrition  and  development,  or  consequences  of 
catarrhal  invasion.  This  view  is,  of  course,  not  entirely  new,  and  is 
even  found  in  text-books  that  dictate  methods  of  treatment  entirely 
founded  on  discredited  mechanical  theories,  but  it  needs  the  impetus 
of  a  vigorous  propaganda  to  be  brought  home  to  the  consciousness 
of  gynecologists  at  large,  and  to  dictate  a  less  mechanical  and  more 
effective  treatment  and  one  more  in  accordance  with  the  true  nature  of 
the  condition. 

But  our  concern  here  is  more  with  the  original  causation  of  this 
affection,  and  this  aspect  of  the  question  is  the  more  important  since 
it  bears  a  direct  relation  to  the  possibility  of  preventing  one  of  the 
most  common  complaints  of  young  womanhood.  Why  should  so  many 
girls  complain  of  these  intense  pains  and  cramps  at  the  occurrence 
of  a  purely  physiologic  and  normal  cyclic  point  in  their  routine  phys- 
ical life?  Varying  amounts  of  discomfort  and  nervous  erethism  are 
probably  natural,  but  this  invalidism  in  health  surely  is  not. 

"We  have  here  heredity  and  environment  again, — an  heredity  of 
neuropathic  tendencies, — if  combined  with  a  neurotic  environment 
being  fully  capable  of  furnishing  a  ready  subject  for  the  affection, 
which  in  its  earlier  stages  can  be  none  other  tliau  an  intensification 
of  the  normal  congestion  of  an  imperfcctly-devclopod  and  imperfectly- 


NATUEB    AND    PREDISPOSING    CAUSES.  5 

nourished  apparatus.  And  we  might  also  consider  the  environment 
of  the  pelvic  organs  themselves,  when  a  habit  of  constipation  causes 
them  to  be  crowded  and  their  blood-supply  diminished  and  vitiated. 

But  two  additional  influences  are  now  required  to  develop  a 
merely  neurotic  functionation  into  one  attended  with  pronounced 
menorrhspasm  and  menorrhalgia,  the  first  step  establishing  the 
uterine  form  and  the  second  the  ovarian  form  of  the  disease:  1.  If, 
coincident  with  this  undue  physiologic  congestion  the  patient  catches 
cold,  with  its  microbic  and  neural  causation,  we  have  an  endometritis, 
constituting  the  uterine  form  of  menorrhalgia.  2.  The  second  step 
is  the  upward  extension  of  the  catarrhal  aggravation  of  normal  con- 
gestion until  the  ovaries  are  affected,  which  is  favored  by  additional 
exposure  to  cold,  artificial  stimulation  of  the  sexual  organs,  the  con- 
traction of  a  marriage  while  still  uncured,  and,  finally,  it  is  to  be  said, 
with  regret,  that  the  operation  of  divulsion  for  the  cure  of  uterine 
menorrhalgia  is  too  frequently  followed  by  an  extension  to  the  ovaries. 

Disorders  of  Maturer  Womanhood. — With  the  regular  establish- 
ment of  the  monthly  cycle  in  her  nature,  woman  has  an  ever-recurring 
test  of  her  well-being,  which  is  also,  in  a  manner,  a  tax  upon  the  asso- 
ciated functions  of  catabolism  and  anabolism,  nutrition  and  waste, 
to  which  it  is  correlated  through  the  sympathetic  nervous  system. 
To  this,  in  the  connubial  state,  is  added  the  full  performance  of  a 
function  which,  normally  conducted,  adds  distinctly  to  her  well-being, 
but  which  is  too  often  attended  with  a  lack  of  common  sense,  pru- 
dence, and  temperance  that  would  put  the  so-called  lower  animals  to 
the  blush.  Throwing  aside  instinct,  which  regulates  so  beautifully 
the  connubial  relations  of  these  same  lower  animals,  man  has  failed 
too  often  to  replace  it  Avith  proper  intelligence  and  control,  and  the 
result  is,  at  times,  harmful  to  the  general  well-being  of  the  individual. 
The  effect  of  excess  in  frequency  alone  is  often  sufficient  to  deceive 
both  patient  and  physician  into  the  belief  that  a  diseased  condition 
exists.  If  to  this  be  added  an  abnormal  performance  of  the  function 
with  the  intent  to  prevent  conception  we  may  have  the  pains  and 
aches  and  weight  sensations  of  actual  disease,  which,  of  course,  baffle 
the  physician  and  his  remedies  so  long  as  the  cause  continues  to  be 
repeatedly  invoked. 

Little  need  be  said,  in  this  place,  of  the  causative  influences  de- 
rived from  the  necessities  and  accidents  of  pregnancy  and  child-birth, 
as  these  are  fully  evident  to  any  practitioner  and  are  usually  rather 


0  DISEASES    OF    WOMEN. 

overstated  than  understated  from  the  mechanical  point  of  view.  It  is, 
indeed,  a  marvel  how  great  are  the  changes  involved  in  the  evolution 
and  involution  of  the  maternal  organs  in  this  physiologic  process, 
without  residual  change,  and  especially  so  when  it  is  remembered  that 
the  evolution  is  so  often  interfered  with  by  tight  lacing  in  younger 
women.  Involution  is,  nevertheless,  so  well  conducted  by  nature 
under  ordinary  conditions  that,  unless  interfered  with,  the  parts  are 
restored  very  nearly  to  their  ante-impregnated  condition  in  a  surpris- 
ingly short  time.  Many  cases  of  gynecic  complaints  arise,  neverthe- 
less, in  interferences  with  this  normal  involution,  the  chief  varieties  of 
interference  being  either  traumatism  or  infection. 

Of  traumatisms  the  most  important  is  laceration  of  the  cervix 
uteri,  for  the  reason  that  the  laceration  permits  an  easy  entrance  to 
the  germs  of  catarrhal  inflammation,  which  is  a  most  important  con- 
comitant of  subinvolution  of  the  uterus.  It  is  nevertheless  a  mistake 
to  confound  the  morbific  effect  of  the  laceration  in  this  early  stage 
with  its  relative  importance  in  the  later  stages.  The  theory  of  Emmett 
as  to  the  pathologic  importance  of  healed  tears  of  the  cervix  has  been 
enormously  overdone,  particularly  in  this  country,  where  the  opera- 
tion of  trachelorrhaphy  has  been  so  frequently  performed  for  either 
general  nervous  symptoms  or  actual  disease  of  the  uterus  supposed 
to  be  due  to  it.  The  connection  is  clearly  fanciful  and  has  no  analogy 
in  similar  causes  of  disease  in  any  other  part  of  the  body.  To  get 
at  its  true  value  one  should  look  carefully  for  cases  of  old  lacerations 
and  compare  the  symptoms  of  those  in  which  the  laceration  alone 
exists,  without  concurrent  clironic  inflammation  of  the  uterus,  with 
those  in  which  this  condition  is  also  associated.  It  will  be  found  that 
the  simple  laceration  is  without  symptoms,  except  the  occurrence  of 
early  miscarriages  when  the  tear  has  been  deep.  This  clearly  indi- 
cates that  the  chronic  metritis  is  the  true  cause  of  the  symptoms. 

In  catarrhal  invasion  of  the  uterine  and  tubal  mucous  tracts  we 
have,  indeed,  the  true  cause  of  the  great  majority  of  the  pelvic  dis- 
eases of  women  as  they  present  themselves  to  the  active  practitioner. 
Some  of  these  are,  of  course,  gonorrheal  in  origin, — the  worst  cases, 
in  fact;  but  that  very  many  are  entirely  free  from  any  etiologic  con- 
nection with  the  gonococcus  has  been  most  abundantly  demonstrated. 
The  germr  of  ordinary  purulent  inflammation  are  practically  ubiqui- 
tous, and  are  ever  ready  to  attack  a  mucous  membrane  in  which  the 
physiologic  resistance  has  been  reduced  either  by  traumatism,  func- 


NATURE    AND    PREDISPOSING    CAUSES.  7 

tional  abuse,  or  the  peculiar  and  as  yet  poorly-understood  neural 
influences  of  "catching  cold." 

That  non-specific  microbic  invasion,  with  its  sequential  war  of 
cells  between  the  microbes  and  the  phagocytes,  is  at  the  bottom  of  the 
great  bulk  of  common  pelvic  diseases  is  as  evident  as  that  a  similar 
catarrhal  process  is  the  principal  pathologic  condition  in  chronic  nasal 
affections.  There  is  also  a  further  analogy  between  the  most  common 
conditions  of  the  two  mucous  tracts  in  the  readiness  with  which  the 
catarrhal  affection  spreads  upward  by  continuity  of  tissue,  in  the 
one  case  affecting  the  Fallopian  tubes  and  ovaries  and,  in  the  other, 
the  Eustachian  and  nasal  tubes,  the  ear,  and  the  eye.  An  important 
conclusion  to  be  drawn  is  that  the  initial  lesion  in  the  uterus  or  nose 
should  receive  primary  attention  in  any  therapeutic  effort.  This  is 
fully  acted  upon,  I  believe,  by  the  ophthalmologists  and  otologists, 
and  was  formerly  well  understood  in  relation  to  the  uterus,  but  the 
nature  of  the  uterine  therapeutics  then  in  vogue — the  application  of 
caustics,  etc.,  to  the  cervix  or  within  the  cavity — was  of  a  character 
to  frequently  aggravate  the  upper  extensions  of  the  affection.  It 
might  justly  be  said,  of  these  methods,  that  they  were  directed  to 
the  uterus  rather  than  to  the  affection  as  a  whole,  with  a  proper 
inclusion  of  its  original  and  still  persistent  seat  in  the  uterus. 

The  recent  surgical  school,  whose  opportunities  for  actually  see- 
ing and  handling  diseased  tubes  and  ovaries  has  justly  brought  this 
portion  of  the  genital  mucous  tract  into  prominence,  has  somewhat 
naturally  fallen  into  the  opposite  extreme  of  neglecting  the  residual 
affection  of  the  uterus  while  paying  all  attention  to  the  tubes  and 
ovaries;  and,  when  the  mode  of  relief  selected  consists  in  simple  re- 
moval of  the  latter  organs,  has  been  confronted  with  a  continuance 
of  the  symptoms  from  the  portion  of  the  affected  structures  left 
behind. 

Catarrhal  disease  of  the  utero-tubal  tract  is  itself  an  entity  and 
should  be  dealt  with  as  a  whole  rather  than  in  some  of  its  parts.  That 
it  is  totally  lacking  in  malignancy,  and  ordinarily  susceptible  of  a 
more  curative  treatment  than  that  by  a  removal  of  some  of  the  organs 
affected  by  it,  is  too  evident  to  be  insisted  upon  were  not  an  opposite 
practice  so  common. 

And  it  should  be  distinctly  understood  that  if  we  eliminate 
uterine  or  more  general  pelvic  inflammation  with  its  results  in  inter- 
stitial hyperplasias  with  or  without  morbid  adhesions,  or,  to  state  it 


8  DISEASES    OF    WOMEN. 

more  practically,  if  these  conditions  be  cured,  we  need  take  no  account 
of  the  exact  position  of  the  uterus  except  it  be  retrotiexed.  to  the 
second  degree  or  prolapsed  at  least  to  the  same  degree.  This  organ 
is  normally  movable  and  capable  of  considerable  deviation  from  its 
position  at  rest;  hence  fixation  in  the  normal  position  is  even  worse 
than  a  movable  displacement.  Wliile  the  badly  displaced,  yet  mov- 
able, uterus  will  give  symptoms  due  to  the  displacement  itself,  much 
of  the  discomfort  is  really  due  to  the  concurrent  endometritis  or  hyper- 
plasia, and  though  it  is  impracticable  at  times  to  so  tone  up  the  weak- 
ened supports  as  to  enable  them  to  regain  their  functions,  we  may  at 
least  relieve  them  of  added  labor  by  reducing  the  bulk  of  the  uterus 
to  normal.  With  this  help  a  complete  restoration  may  be  ultimately 
gained  without  resorting  to  the  temporary  expedient  of  pessary  wear- 
ing, which  only  adds  to  the  atrophy  of  the  natural  supports. 


CHAPTEK  II. 

On  the  Examination  of  Cases  with  Refeeence  to  the 

Propeiety  of  Employing  Conseevative 

Methods  of  Treatment. 

It  cannot  be  said  that  the  physician  who  is  skilled  in  the  appli- 
cation of  electricity  and  other  conservative  methods  in  gynecology 
has  as  great  a  moral  responsibility  for  accurate  diagnoses  as  the  sur- 
geon, for  the  cost  in  lost  functions  or  lost  lives  of  the  surgeons'  mis- 
takes are  out  of  all  proportion  to  any  consequences  of  the  mistaken 
diagnosis  of  the  former.  Yet  a  responsibility  for  accuracy  in  diag- 
nosis and  treatment  is  inherently  associated  with  all  medical  work, 
and  in  no  department  of  therapeutic  management  is  the  importance 
of  an  accurate  conception  of  the  true  nature  of  the  disease  of  more 
value  than  in  electro-gynecology,  for  in  this  work  both  the  indications 
of  treatment  and  the  special  technique  of  applications  to  different 
affections  are  unusually  clear.  There  is,  moreover,  a  two-sided  respon- 
sibility involved  in  the  examination  of  cases  with  a  view  to  the  pro- 
priety of  electric  treatment,  for,  while  desirous  of  making  all  possible 
applications  of  an  art  that  is  capable  of  restoring  health  in  so  many 
cases  ivitJiovt  injury  or  loss  of  organs  or  risk  to  life,  the  physician 
should  not  make  the  mistake  of  counseling  the  employment,  or  at- 
tempt to  employ,  this  method  in  cases  where  the  blessings  of  modern 
aseptic  surgery  are  both  proper  and  expedient.  It  is  the  abuse  and  not 
the  proper  use  of  surgical  methods  that  should  be  avoided. 

The  electro-gynecologist  should  therefore  be  a  trained  specialist 
in  the  diseases  of  women,  in  its  fullest  sense,  though  his  highest  use- 
fulness will  be  lessened  by  a  simultaneous  ambition  to  be  a  great  ab- 
dominal surgeon,  for  the  temptation  to  use  his  surgical  skill  in  that 
most  attractive  field  may  curtail  his  employment  of  electricity,  which, 
though  at  times  slow  in  producing  cures,  may,  even  in  these  tardy 
cases,  yield  the  most  brilliant  results  as  a  reward  of  patient  persistence. 

In  certain  classes  of  cases  a  training  in  neurology  is  equallv  im- 

(9)    ' 


10  DISEASES    OF    WOMEN. 

portant,  for  it  is  a  heresy  of  the  age,  leading,  at  times,  to  dire  results, 
that  regards  the  diseases  of  women  as  merely  mechanical  and  surgical. 

And  that  the  electro-gynecologist  should,  first  of  all,  be  a  physi- 
cian, in  the  broad  sense  of  the  designation,  fully  alive  to  the  consti- 
tutional, diathetic,  assimilative,  and  eliminative  conditions  of  his 
patient  goes  without  saying,  for  it  is  self-evident  that  the  true  special- 
ist is  only  he  that  adds  something  to  the  broadest  training  of  the  well- 
educated  physician. 

Last,  but  by  no  means  least,  he  should  be  thoroughly  familiar 
with  the  physics  of  electricity, — an  elementary  subject  that  should 
be  mastered  by  the  student,  together  with  other  natural  sciences,  be- 
fore he  is  permitted  to  enter  a  medical  college.  In  default  of  this 
previous  training,  or  in  case  of  decided  rustiness,  the  reader  is  advised 
to  turn  at  once  to  the  second  portion  of  this  work,  where  will  be  found 
a  complete  elementary  introduction  to  general  electro-therapeutics. 

General  Examination  and  Classification  of  Cases. — When  a  patient 
presents  herself  with  a  self-evident  affection,  such  as  a  large  neoplasm, 
either  benign  or  malignant,  or  other  patent  condition  well  under- 
stood by  herself  and  her  previous  medical  attendants,  there  is  no  diffi- 
culty in  at  once  placing  the  case  in  a  general  class  for  further  special 
study.  If,  on  the  contrary,  the  pain,  tenderness,  weakness,  or  other 
subjective  complaints  point  to  merely  an  abnormal  condition  of  func- 
tionation  of  some  organ  or  group  of  organs,  greater  care  must  be  exer- 
cised in  this  preliminary  placement  of  the  case,  for  it  is  particularly 
in  this  stage  of  examination  that  many  women  have  been  assumed 
to  have  pelvic  disease  who  really  suffered  from  some  form  of  nervous, 
constitutional,  or  abdominal  disease,  the  artificial  ideas  of  the  proper 
position  and  shape  of  the  pelvic  organs  yet  partially  prevalent  among 
gynecologists  inducing  the  adoption  of  measures  that  had  no  bearing 
whatever  on  the  real  affection.  Chronic  constipation  or  other  func- 
tional derangement  of  the  digestive  tract,  and  particularly  displace- 
ments and  dilatations  of  the  stomach  and  large  intestine  and  relaxa- 
tion of  the  abdominal  walls,  have  done  duty  for  all  manner  of  organic 
diseases  of  the  pelvic  organs.  But  it  is  in  the  mistaking  of  nervous 
affections  for  pelvic  diseases  that  the  errors  of  apparently  good  diag- 
nosticians have  been  most  numerous  and  harmful  during  the  past 
twenty  years,  due  to  a  conjunction  of  circumstances  such  as  ignorance 
of  neurologic  science;  ultramechanical  ideas  of  the  position  and  shape 
of  the  uterus;  an  exaggerated  belief  in  the  frequency,  effect,  and  in- 


EXAMINATION    OF    CASES.  11 

curability  of  ovarian  diseases;  and  an  assumption  that  gynecology 
had  no  relationship  to  any  other  branch  of  medicine  than  surgery. 
It  is  to  these  facts  that  we  owed  the  long-drawn-out  epidemic  of  pes- 
sary wearing  by  women  who  had  not  the  slightest  need  for  such  an 
unnatural  and  often  harmful  skeleton  within  the  vagina,  and  that 
to-day  we  are  far  from  blessed  with  the  knowledge  that,  in  the  opinion 
of  our  misguided  friends,  about  every  third  woman  in  the  community 
must  have  her  pelvic  organs  torn  open,  sewed  up,  scraped  with  vigor, 
torn  loose  from  their  adhesions,  sewed  up  to  the  abdominal  wall  to 
form  adhesions,  cut  out  and  put  into  alcohol,  or  otherwise  disposed 
of.  Aside  from  such  bizarre  experiences  as  the  removal  of  an  ovary 
for  pain  due,  in  reality,  to  lateral  sclerosis  of  the  spinal  cord,  and  the 
removal  of  both  ovaries  for  similar  symptoms  due  to  scoliosis  of  the 
spinal  column,  both  of  which  instances  occurred  in  cases  known  to 
the  author  at  the  hands  of  distinguished  surgeons,  my  readers  can 
doubtless  recall  scores  out  of  the  thousands  of  cases  where  equally 
vigorous  pelvic  treatment  has  followed  attempts  to  diagnose  nervous 
troubles  obscurely  pointing  to  the  pelvis,  and  where  the  chief  error  of 
treatment  was  not  due  to  a  lack  of  the  broad  training  that  a  specialist 
should  possess,  but  rather  to  a  failure  to  make  a  careful  preliminary 
study  of  a  case  that  was  in  itself  inherently  difficult  of  exact  deter- 
mination, yet  M^hich,  if  studied  thoroughly,  would  have  yielded  nega- 
tive indications  at  least  for  the  radical  measures  employed. 

It  is  therefore  our  chief  duty,  in  these  obscure  cases,  to  deter- 
mine the  relation  of  the  symptoms  (1)  to  constipation,  which  is  un- 
usual in  cases  that  are  sent  to  the  specialist  in  private  practice,  but 
frequent  in  general  practice  and  dispensary  work;  (2)  to  other  digest- 
ive, assimilative,  or  eliminative  disturbances,  such  as  gout,  rheuma- 
tism, etc.;  (3)  to  abdominal  relaxation,  gastroptosis,  or  enteroptosis; 
(4)  to  neurasthenia  or  hysteria;  (5)  to  probable  neuralgia  of  the  pelvic 
nerves,  as  evidenced  by  sciatic  or  other  neuralgias;  (6)  to  organic 
affections  of  the  spinal  nervous  system;  or  (7)  to  true  pelvic  disease. 

The  physician  who  is  familiar  with  electric  methods  is  placed 
at  a  distinct  advantage  in  summing  up  the  probability  of  which  ele- 
ment in  the  case  is  the  prime  factor  of  the  disease  when  confronted 
with  an  instance  in  which  decision  is  difficult,  for  he  may  embrace 
both  horns  of  the  dilemma  with  the  greatest  propriety  and  with  the 
best  results  to  the  patient.  And  as  the  truth  in  the  cases  of  moderate 
pelvic  disease  associated  with  a  functional  nervous  affection  often  lies 


12 


DISEASES    OF    WOMEN. 


between  the  two  as  chief  etiologic  factors,  no  other  course  than  the 
simultaneous  treatment  of  both  affections  is  equally  effective  without 
loss  of  time,  money,  and  energy. 

The  ordinary  questions  of  a  careful  note-taker  as  to  family  and 
personal  history  having  formed  the  initial  portion  of  the  examination, 
it  is  immaterial  whether  this  general  examination  and  autoconsulta- 
tion  precedes  or  follows  the  local  examination,  provided  it  has  a  due 
place  in  the  investigation  and  precedes  the  formation  of  an  opinion. 

Examination  of  the  Abdomen. — The  local  examination  of  the 
patient,  which  should  invariably  be  conducted  with  the  assistance  of 


Fig.  1. — Dorsal  position.     (Drawn  from  photograph  of  model.) 


a  nurse  or  other  third  party,  requires  that  the  corsets  be  removed  and 
all  bandages  about  the  waist  loosened,  permitting  the  whole  abdomen 
to  be  readily  examined.  The  patient  having  been  placed  in  the  dorsal 
position  (Fig.  1)  with  bladder  and  rectum  empty,  the  abdominal  re- 
gions should  receive  the  first  attention,  as  inspection  and  palpation  of 
this  most  important  portion  of  the  body  will  not  only  detect  or  exclude 
disease  of  its  various  organs,  but  will  also  give  important  information 
of  the  general  nutritive  condition  of  the  patient.  To  proceed  at  once 
to  the  pelvic  examination,  as  generally  advised  in  the  text-books,  is 
to  overlook  very  valuable  sources  of  information. 

Inspection  w\]],  in  addition  to  the  information  afforded  as  to  gen- 


EXAMINATION    OF    CASES. 


13 


eral  nutrition,  give  evidence  of  any  existing  or  antecedent  stretchings 
of  tlie  skin  due  to  pregnancy,  ascites,  or  tumors. 

Palpation  is  most  important  in  the  general  information  which 
it  gives  and  as  a  means  for  the  discovery  and  the  estimation  of  the 
nature,  situation,  and  size  of  tumors.  This  should  be  conducted  with 
the  full  palmar  surface  of  the  fingers,  and  not  with  the  tips  alone, 
and  on   the  full  education  of  the  fingers  in  this  art  will  depend  much 


RIGHT 
4HYPOCHONDR1*.C 


Limit  of    f, 
- — c<^i 


'~^p/i> 


Left 


lobe. 


/     '•\piCASTRIC 


JY'POCHONDRIAc} 


Fig.  2. — Diagram  of  abdominal   regions,   showing  position   of 
viscera.     (After  Gray.) 


of  the  diagnostic  skill  of  the  examiner,  the  bimanual  examination  of 
the  pelvis  alone  exceeding  it  in  value.  A  form  of  bimanual  examina- 
tion of  the  abdomen  may  be  of  value  in  thin  subjects  in  which  the 
other  hand  is  passed  under  the  patient's  back  (Fig.  3).  This  will  give 
important  information  concerning  the  true  situation  of  the  anterior 
hand  in  relation  to  the  spinal  column,  the  rim  of  the  pelvis,  the  kid- 
neys, and  other  normal  structures,  and  permit  of  a  more  perfect  appre- 
ciation of  small  abdominal  tumors  and  displaced  organs. 


14 


DISEASES    OF    WOMEN. 


Mensuration. — In  the  larger  tumors  and  abdominal  enlarge- 
ments exact  measurements  should  be  taken  and  recorded  of  the  shape 
and  size  oi  the  growth  for  subsequent  reference  in  ascertaining  the 
extent  of  shrinkage.  The  measurements  are  to  be  taken  from  certain 
fixed  points  appropriate  to  each  case,  such  as:  the  height  above  the 
level  of  the  anterior  superior  spines  of  the  ilium,  the  distance  above  or 
below  the  navel,  or  the  extreme  height  of  the  tumor  from  a  less  easily 
fixed  point  on  the  pubic  symphysis.  Measurements  of  the  breadth  of 
abdominal  tumors  may  be  made  directly,  or,  in  very  large  tumors,  by 


Fig.  3. — Bimanual  abdominal  palpation.     (Drawn  from  model.) 


taking  the  distance  from  each  anterior  superior  spine  of  the  ilium  to 
the  navel  (in  symmetrical  tumors,  directly  from  spine  to  spine). 

Since  increased  health  coincident  with  the  retrogression  of  fibroids 
will,  at  times,  be  accompanied  by  an  increased  thickness  or  firm- 
ness of  flesh  in  the  abdominal  wall,  Apostoli  advises  th&t  the  thick- 
ness of  a  double  layer  of  these  tissues  be  taken  by  pinching  them  up 
in  the  hand  and  measuring  with  calipers.  This  is  only  of  importance 
in  accurate  measurements  of  slight  changes,  for  it  is  never  great.  The 
additional  tone  of  the  abdominal  muscles  under  treatment  is  apt  to 


EXAMINATION    OF    CASES. 


15 


convey  to  the  patient  the  sensation  that  any  increase  of  bulk  is  really 
a  decrease. 

When  the  abdominal  walls  are  relaxed,  either  with  or  without  the 
association  of  tumors  or  other  affections,  the  extent  and  importance 
of  the  relaxation  is  best  determined  by  having  the  patient  stand  with 
abdomen  uncovered  or  even  by  lying  on  one  side.  I  have  known 
patients  who  firmly  believed  that  they  possessed  tumors,  owing  to  the 
enormous  relaxation  revealed  in  the  standing  position,  the  true  extent 


Fig.  4. — Abdominal  relaxation,  as  shown  in  the  erect  position. 


of  which  tax  upon  her  strength  was  far  from  evident  in  the  dorsal 
position  (Fig.  4). 

Examination  of  the  Pelvis. — Dorsal  Position.~The  patient  re- 
maining in  the  dorsal  position,  an  inspection  of  the  vulva  is  now 
made  in  a  new  case  for  the  discovery  of  possible  evidences  of  a  spe- 
cific condition,  anomalies,  or  of  relaxation  of  the  vulvar  outlet.  The 
next  step  is  the  insertion  of  the  forefinger  to  find  the  position  of  the 
OS  preparatory  to  the  insertion  of  a  bivalve  speculum  (Fig.  5)  foi 


16  DISEASES    OF    WOMEN. 

ocular  inspection  of  the  condition  of  the  vaginal  walls  and  muscular 
structures,  the  condition  of  the  os  as  to  the  effect  of  previous  accouche- 
ments,  and  the  existence  of  laceration  or  of  erosion.  This  portion  of 
the  examination  has  an  important  bearing  on  the  accuracy  of  the 
diagnosis,  since  it  not  only  informs  us  accurately  of  the  existence  of 
relaxation  of  the  vaginal  outlet  and  its  nature  and  extent  (Plate  XIX) 
and  of  the  condition  of  the  vaginal  surfaces,  but  by  permitting  us  to 
see  the  nature,  color,  and  consistence  of  the  uterine  discharges,  if  any 
exist,  enables  us  to  locate  the  origin  of  the  discharge, — a  most  impor- 
tant step  in  the  accurate  treatment  of  these  affections.  (See  Plates 
X  to  XVIII.) 

Bimanual  Touch. — Most  valuable  information  of  the  condition 
of  the  uterine  body  as  a  whole,  of  the  tubes,  ovaries,  and  periuterine 


Fig.  5.- — Goodell  speculum,  latest  pattern. 


space,  is  derivable  from  the  next  step  of  the  examination, — the  biman- 
ual touch  (Fig.  6),  the  cultivation  of  which  creates  the  true  tadus 
eruditus  of  the  gynecologist.  By  the  educated  finger  within  the 
vagina,  assisted  by  the  educated  fingers  of  the  opposite  hand  palpating 
above,  a  tactile  intelligence  may  be  evolved  only  comparable  to  the 
education  of  the  tactile  sense  in  the  blind,  capable  of  mapping  out 
with  precision  any  morbid  condition  within  the  pelvis,  unless  the 
subject  is  inordinately  obese.  It  is  not  claimed,  of  course,  that  the 
exact  nature  of  the  morbid  condition  may  be  thus  determined,  though 
the  association  of  subjective  and  other  objective  symptoms  may  en- 
able us  to  come  very  close  to  it;  but  it  is  claimed  that  the  educated 
touch  is  capable  of  making  a  diagnosis  that  will  fully  warrant  the 
institution  or  rejection  of  electric  or  other  conservative  treatment,  if 


EXAMINATION    OF    CASES. 


17 


it  could  not  so  easily  warrant  a  major  operation.  An  intra-uterine 
treatment  constitutes  also  an  additional  means  of  diagnosis  (page  114), 
as  pointed  out  by  Apostoli,  thus  rendering  absolutely  unnecessary  that 


Fig.  6. — Bimanual  pelvic  examination. 

terrible  alternative  advocated  by  some, — an  abdominal  section  for 
diagnosis. 

The  Sound. — Nothing  has  been  said  of  the  passage  of  the  uterine 
sound  (Fig.  7)  for  the  simple  reason  that  the  author  condemns  it  as  a 
means  of  diagnosis  in  any  form  of  uterine  trouble  except  tumors,  for 
the  reason  that  all  of  its  indications,  except  the  depth  of  the  cavity, 
can  be  determined  with  equal  facility  by  the  skilled  bimanual  touch. 


Fig.  7. — Simpson's  sound. 


The  depth  of  the  cavity  is  of  value  as  a  means  of  comparison  from 
time  to  time  and  may  be  taken  during  any  intra-uterine  applications 
that  are  made.     An  exception  to  this  condemnation  of  the  sound  is 


18  DISEASES    OF    WOMEN. 

imperative  in  the  first  examination  of  fibroids  and  in  the  discrimina- 
tion between  these  neoplasms  and  ovarian  tumors  or  other  periuterine 
tumors  closely  approximated  to  the  uterus.  When  so  used  it  should  be 
inserted  without  a  speculum  by  passing  the  tip  along  the  index  finger 
placed  in  the  vagina,  the  instrument  being  held  very  lightly  between 
the  index  finger  and  thumb  of  the  opposite  hand,  thus  enabling  it  to 
be  inserted  with  the  greatest  gentleness.  After  engaging  the  cervix 
the  handle  is  brought  down  between  the  thighs  to  enable  the  curved 


Fig.  8. — Method  of  inserting  sound  by  toucli.    The  finger  is  sliown 
behind  the  cervix. 


portion  at  the  tip  to  coincide  in  direction  with  the  cervix,  as  it  is 
known  to  be  at  the  moment  by  the  touch,  and  when  thus  inserted  it 
may  be  made  to  follow  the  actual  direction  of  the  cavity  with  least 
disturbance,  the  sound  becoming  a  prolongation  of  the  delicate  tactile 
organs  of  the  finger.  This  method  of  inserting  the  sound  has  been 
popularized  by  Apostoli,  and,  when  one  is  familiar  with  it,  its  immense 
advantage  over  any  other  method  in  which  the  touch  does  not  take 
part  is  most  evident.     The  cut  (Fig.  8)  has  been  carefully  drawn  to 


EXAMINATION    OF    CASES. 


19 


illustrate  the  method  as  practiced  by  the  author,  showing  the  finger 
behind  the  cervix,  which  it  draws  slightly  forward  when  this  por- 
tion of  the  uterus  points  too  far  back. 

A  method  of  insertion  of  the  sound  practiced  by  some,  in  which 
the  cervix  is  caught  with  vulsella  forceps  and  dragged  downward, 
should  be  condemned  as  unnecessarily  barbarous,  liable  to  produce 
injury  if  the  adnexa  are  adherent,  and  unable  to  convey  to  the  oper- 
ator any  intelligent  information  as  to  the  direction  in  which  the 
instrument  should  be  passed. 

Abdominal  palpation  may  be  conjoined  with  the  sound  in  the 


Fig.    9. — Sims's   position.      (From   photograph   of   model.) 


diiferential  diagnosis  of  tumors  projecting  above  the  pelvic  brim,  a 
slight  movement  being  given  to  the  uterus  to  determine  whether  it  is 
intimately  connected  with  the  tumor. 

Rectal  Touch. — This  is  an  important  proceeding  when  the  vaginal 
touch  has  disclosed  obscure  conditions  in  the  posterior  pelvic  regions,, 
and  should  be  practiced  just  before  the  termination  of  the  examina- 
tion on  account  of  the  fingers  becoming  soiled.  It  is  also  of  great 
value  as  a  sole  means  of  examination  in  virgins.  The  bimanual  rectal 
touch  is  practiced  in  the  same  manner  as  the  vaginal  procedure. 

Sims's  Position. — The  use  of  Sims's  position  and  speculum  (Fig. 


20  DISEASES    OF    WOMEN. 

9)  are  far  less  frequently  necessary  in  the  conservative  treatment  of 
the  diseases  of  women  than  in  operative  procedures,  though,  at  times, 
valuable  in  applications  to  the  cervix  and  vault  of  the  vagina  and  in 
electropuncture,  though  even  in  the  latter  operation  the  dorsal  posi- 
tion is  preferable  for  any  but  the  most  superficial  punctures,  on 
account  of  the  use  of  the  finger  in  directing  the  instrument.  The 
proper  attitude  for  this  examination  is  shown  in  the  cut,  the  side  of 
the  table  on  which  the  hips  rest  being  slightly  elevated  to  raise  the 
vulvar  outlet  above  the  level  of  the  vault  in  order  that  pneumatic 
pressure  may  dilate  the  vagina  when  air  is  admitted.  The  speculum 
(Fig.  10)  should  be  inserted  by  separating  the  labia  with  the  fingers 
of  the  left  hand,  holding  the  instrument  in  the  right  by  its  opposite 
extremity;  the  point  of  the  blade  is  placed  on  the  posterior  com- 
missure and  slipped  into  the  vagina  in  a  backward  and  upward  direc- 


10. — Sims's  speculuiu. 


tion.  After  adjusting  the  tip  in  a  manner  to  bring  the  desired  por- 
tion under  view  the  instrument  is  intrusted  to  the  nurse,  who  stands 
with  her  left  side  toward  the  patient  (Fig.  11). 

Illumination. — A  good  Xorth  light  will  generally  be  sufficient 
for  an  ordinary  specular  examination,  but  a  more  powerful  illumina- 
tion is  of  value  in  electrolytic  operations  on  small  neoplasms,  etc., 
within  the  vagina.  The  methods  of  artificially  illuminating  the 
vagina,  and  also  the  technique  and  value  of  transillumination  of  the 
pelvis  a=  an  assistance  to  diagnosis,  are  fully  treated  on  page  353. 

Aspiration. — A  most  important  occasional  means  of  positive 
diagnosis  in  some  pelvic  and  abdominal  tumors  where  a  cystic  con- 
dition is  suspected  is  the  puncture  of  the  tumor  by  a  long  slender 
needle  with  capillary  tube,  attached  to  an  aspirator,  by  which  we  may 
determine  the  presence  of  a  liquid  and  extract  a  portion  of  it  for  diag- 


EXAMINATION    OF    CASES. 


21 


nosis,  and  also  in  certain  cases  as  a  remedial  measure  (Fig.  12).  The 
delicate  nature  of  these  needles  makes  it  possible  to  traverse  many 
organs  and  tissues  with  impunity,  though  the  careful  operator  will  usu- 
ally be  able  to  insert  it  quite  directly  into  the  presenting  portion  of  the 
tumor  without  taking  unnecessary  risks.  The  imprisoned  sac  in  intes- 
tinal hernia,  the  bladder  threatened  Avith  rupture,  and  the  large  intes- 
tine distended  with  gases  have  all  been  safely  punctured  with  this 
instrument,  and  the  needle  may  be  used  as  a  negative  electrode  when 


Fig.  11. — Attitude  of  nurse  in  Sims's  position, 
photograph  of  model.) 


(Drawn  from 


inserted  into  a  tumor,  if  thought  wise,  after  the  liquid  has  been  with- 
drawn, by  previously  coating  it  with  a  thin  layer  of  fused  hard  rubber 
to  a  short  distance  of  the  point,  and  connecting  it  with  the  negative 
pole  of  the  battery  by  twisting  a  fine  copper  wire  about  its  base. 
When  so  used  the  hydrogen-gas  and  liquids  of  electrolysis  are  drawn 
into  the  aspirator  reservoir  in  great  quantity. 

The  aspirator  acts,  of  course,  on  the  principle  of  producing  a 
vacuum  in  the  reservoir-bottle  by  means  of  a  suction  air-pump  con- 


22 


DISEASES    OF    WOMEN. 


nected  with  it  by  a  stout  rubber  tube,  the  needle  being  attached  to 
another  tube  connected  with  the  top  of  the  reservoir. 

Great  care  should  be  observed  in  asepticizing  the  needles  and 
tubes  before  and  after  use,  the  needle  being  either  boiled  or  passed 
over  the  flame  of  an  alcohol-lamp  immediately  before  use,  no  matter 
what  the  previous  cleaning  may  have  been,  and  the  spot  where  it  is  to 
be  inserted  should  be  cleaned  with  sublimate  solution  if  within  the 
vagina  or  sublimate  solution  followed  by  alcohol  if  on  the  abdominal 
surface.  Chloride-of-ethyl  spray  will  make  the  external  puncture 
painless. 


Fig.  12. — Aspirator. 


Aseptic  Precautions  in  Routine  Gynecic  Practice  and  Electro- 
gynecology. — The  hands,  and  particularly  the  fingers  and  finger-nails, 
should  be  scrupulously  clean  when  making  any  examinations  or  appli- 
cations, the  use  of  the  nail-cleaner,  scrubbing-brush,  and  soap  and 
water  being  amply  sufficient  when  the  mucous  membrane  is  unbroken. 
No  instrument  of  any  character  should  be  employed  unless  absolutely 
aseptic,  the  author  making  the  following  arrangements  for  this  pur- 
pose: All  sounds  and  intra-uterine  electrodes  are  first  thoroughly 
washed  in  soap  and  water  and  then  passed  through  the  flame  of  an 
alcohol-lamp  or  Bunsen  burner,  and  no  instrument  of  this  nature  is 
inserted  into  the  uterus  that  cannot  be  so  asepticized.  All  metal 
instruments  likely  to  be  injured  by  this  heat,  such  as  specula,  forceps, 


EXAMINATION    OF    CASES.  23 

etc.,  are  boiled  before  use.  Electrodes  with  rubber  insulation  not 
fused  on  the  shank,  which  I  reject,  if  possible,  in  favor  of  those  that 
have  a  fusible  insulation,  are  dipped  in  boiling  water  and  thoroughly 
scrubbed  with  soap  and  water,  or  are  kept  in  a  3-per-cent.  solution  of 
carbolic  acid  or  lO-per-cent.  acetanilid  solution.  The  electrodes  with 
fusible  insulation  are  heated  in  the  flame  and  asepticized  by  re-fusing 
the  covering.  All  cotton  pads  or  other  external  electrodes  that  are  used 
for  more  than  one  patient  are  boiled  before  use,  a  small  gas-stove 
being  very  convenient  for  this  purpose. 


CHAPTER  III. 

Introductory  Remarks  on  Electricity  as  a  Remedy  in 
Gynecology. 

The  systematic  use  of  electricity  in  certain  affections  peculiar  to 
women  had  its  inception  in  the  labors  of  Tripier,  who,  as  far  back  as 
1859,  began  a  series  of  publications  that  show  a  profound  study  of  the 
value  of  electricity  in  the  trophic  and  mechanical  lesions  of  the  uterus 
and  other  pelvic  organs.  Numerous  and  fruitful  essays  have  appeared 
from  the  same  pen  at  frequent  intervals  since,  the  whole  amply  suffi- 
cient in  themselves  alone  to  stem  the  tide  of  excessive  surgical  inter- 
ference in  gynecology  that  began  simultaneously  with  his  work,  but 
outstripped  it  so  widely.  But  Tripier  has  not  been  understood  by  his 
contemporaries.  Electro-therapeutics  itself  and  all  writers  on  it  were 
assumed  to  be  concerned  with  nervous  diseases  alone,  and  what  litera- 
ture existed  was  inaccessible  to  gynecologists.  It  remained  for  Apostoli 
to  successfully  attract  the  attention  of  specialists  in  the  diseases  of 
woman  by  the  persistent  advocacy  of  his  discovery  of  the  value  of 
scientifically-applied  currents  in  the  treatment  of  fibroid  tumors,  by 
methods  that  resulted  in  a  distinct  advance  in  the  general  application 
of  electricity  in  medicine.  This  invasion  of  what  had  been  regarded 
as  an  exclusively  surgical  field  received  conspicuous  and  bitter  criti- 
cism from  the  many  stalwart  defenders  of  a  faith  that  laid  aside  all 
else  in  gynecology  but  the  knife.  In  America  and  England  particu- 
larly the  discussions  have  been  numerous  and  acrimonious,  and  doubt- 
less many  extravagant  claims  appeared  on  both  sides;  but  as  a  result 
it  may  be  said  that  electricity  has  been  rescued  from  its  exclusive 
position  as  a  toy  in  the  hands  of  the  neurologists,  too  many  of  whom 
intrusted  its  crude  applications  to  unintelligent  nurses,  and  has  won 
for  itself  an  important  place  in  the  curative  therapeutics  of  gynecol- 
ogy. As  a  natural  consequence,  an  improvement  has  also  appeared 
in  the  application  of  electricity  to  nervous  diseases, — a  result  that 
could  not  have  been  hoped  for  under  previously-existing  conditions. 

Apostoli's  work  was,  of  course,  but  the  medical  application  of 
(24) 


ELECTRICITY    AS    A    REMEDY.  25 

that  swelling  tide  of  electric  knowledge  that  has  so  suddenly  altered 
the  mechanical  surroundings  of  mankind.  It  was,  indeed,  high  time 
that  the  recent  advancements  in  electric  science  should  be  applied  to 
medicine,  its  oldest  service  to  man,  when  Apostoli  described,  in  1882, 
his  device  of  the  clay-pad  diffusion-electrode  for  the  painless  dis- 
persion, on  the  outside  of  the  body,  of  the  powerful,  measured  cur- 
rents concentrated  at  will  within.  Conceived  on  lines  previously 
enunciated  by  Erb,  the  method  was  the  first  demonstration  since  the 
era  of  electric  measurement  of  the  possibility  of  using  really  effective 
currents  within  the  body. 

How  Electricity  Becomes  a  Remedy. — The  intimate  connection 
between  electricity  and  physiologic  and  pathologic  processes  has  re- 
cently been  considered  by  Prof.  A.  E.  Dolbear,  the  eminent  phys- 
icist of  Tuft's  College,  Cambridge,  Mass.,  in  a  paper  read  before  the 
American  Electro-Therapeutic  Association  at  its  Boston  meeting  in 
1896.  He  deprecated  all  allusion  to  electricity  as  a  force  external  to 
matter  and  independent  of  it.  Electricity,  light,  heat,  and  chemic 
action  are  inherent  properties  of  matter,  electricity  being  the  rotatory 
property  of  atoms,  light  the  vibratory  property,  etc.  They  are  but 
manifestations  of  atomic  energy  which  are  continuously  present  in 
the  interchanges  of  atoms  in  the  molecular  activities  incident  to  life. 
The  higher  the  form  of  tissue,  the  greater  the  amount  of  energy 
absorbed  in  cellular  activities. 

"The  factors  of  physiologic  phenomena  are  the  kinds  of  matter 
found  in  organic  things  and  the  kinds  of  motioji  and  energy  which 
give  the  kinds  of  matter  their  characteristic  properties.  The  phe- 
nomena exhibited  with  these  factors  depends  upon  the  inherent  quali- 
ties of  the  atoms  themselves,  and  it  is  certain  that  the  old  notions 
concerning  their  nature  and  possibilities  must  be  profoundly  changed, 
for  the  old  is  altogether  inadequate  and  no  one  to-day  knows  enough 
to  say  what  matter  cannot  do,  for  such  a  one  makes  ignorance  do 
duty  for  knowlege.  What  can  be  strongly  stated  is  that  the  variable 
factors  are  heat  and  electricity,  for  these  determine  chemic  reactions, 
in  the  body  as  w^ell  as  out  of  it.  For  a  long  time  heat  was  the  only 
physical  factor  employed  for  chemic  purposes  in  inorganic  processes. 
Lately  electricity  has  been  utilized  and  has  made  possible  many 
reactions  which  were  either  impossible  or  required  a  long  time  to 
effect,  such  as  the  reduction  of  alumina,  the  tanning  of  leather,  and 
the  making  of  potassium  chlorate  and  sodium  carbonate.     Is  it  not 


26  DISEASES    OF    WOMEN. 

altogether  probable  that  the  selective  chemistry  of  tissues  of  all  kinds 
is  to  be  helped  in  like  manner  by  employing  the  same  agent,  and  that 
only  present  lack  of  knowledge  prevents  its  successful  use  in  promot- 
ing normal  physiologic  processes  and  destroying  abnormal  ones? 
Anthropologists  are  telling  us  there  are  few,  if  any,  individuals  of  any 
race  that  are  thoroughly  sound,  that  all  are  in  a  more  or  less  diseased 
condition.  That  means  that  cellular  structure  does  not  distribute  to 
physiologic  structure  the  proper  kind  and  amount  of  physical  energy 
needed.  The  trouble  is  with  the  cells,  not  the  organs.  And  the 
trouble  with  the  cells  is  instability  due  to  lack  of  available  energy, 
ultimately  electric,  if  there  be  any  truth  in  what  seems  to  be  implied 
in  all  molecular  structure,  for  every  atom  has  its  electro-chemic  equiv- 
alent or  electric  energy,  which  is  disposed  in  this  way  or  that  as  it  is 
held  more  or  less  stable  in  its  molecule." 

This  suggestive  extract  from  Professor  Dolbear's  paper  gives  un- 
questionably the  true  basis  of  the  medicinal  value  of  electricity.  In 
biief,  it  may  be  f-aid  that  by  its  use  we  have  a  means  of  altering  at 
will  the  molecular  activities,  the  selective  chemistry,  of  both  super- 
ficial and  deep-seated  parts  of  the  body,  and  this  i&  done,  not  by  the 
addition  of  foreign  substances  or  even  a  foreign  force  to  the  body, 
but  by  a  simple  alteration  of  its  cellular  activity,  on  which  all  organic 
functions  depend. 

To  affect  molecular  activities  in  a  special  organ,  which  may  be 
deep-seated,  it  is  therefore  apparent  that  we  must  so  concentrate  our 
"current"  of  rotatory  molecular  excitation  from  some  artificial  source 
external  to  the  body  that  it  may  traverse  that  organ  and  be  dense 
enough  in  transit  to  accomplish  its  purpose.  This  current,  which,  if 
galvanic,  is  always  issuing  from  its  source  in  a  definite  direction,  only 
circulates  when  the  path  back  to  its  source  or  to  earth  is  complete. 
To  place  the  body  in  this  path  or  circuit  we  must  apply  two  conduct- 
ing contacts  (electrodes)  to  its  surface  or  within  its  substance,  between 
which  the  current  will  spread  out  as  it  traverses  the  intervening 
tissues.  The  electrode  at  which  the  current  enters  the  body  is  called 
the  positive  pole,  and  is  generally  indicated  by  the  +  sign;  that  at 
which  it  leaves  is  called  the  negative  pole,  with  the  —  sign.  In  addi- 
tion to  the  molecular  excitation  referred  to,  which  is  present  in  all 
portions  of  the  circuit  through  the  body  in  proportion  to  the  local 
density  of  the  lines  of  flow,  special  chemic  and  molecular  effects  on 
living  tissue  attend  the  current  at  entrance  and  on  leaving  the  body; 


ELECTRICITY    AS    A    REMEDY.  Z7 

hence  the  two  poles  have  distinct  and  separate  physical  and  thera- 
peutic elTects  (page  40). 

It  is  only  necessary  to  add  to  these  hints  at  the  mode  of  action  of 
electricity  as  an  internal  remedy  that  an  intensification  of  the  same 
molecular  activities  by  concentration  of  current  is  the  explanation  of 
the  destruction  of  tumors  of  the  body-surface  and  accessible  cavities, 
where  molecular  activity  is  conducted  to  the  final  step  of  a  resolution 
of  tissue  into  its  ultimate  inorganic  elements. 

Special  Value  of  Electricity  in  Gynecology. — The  foregoing  re- 
marks indicate  the  basis  of  a  wide  applicability  of  electricity  to  the 
cure  of  diseased  organs  in  general.  That  its  value  in  chronic  affec- 
tions of  many  kinds  is  but  imperfectly  appreciated  by  the  profession 
is  only  too  true  (and  this  may  be  largely  imputed  to  its  but  recent 
availability  in  mensurable  quantity),  yet  there  are  two  special  reasons 
for  its  recent  agitation  as  a  remedy  in  the  diseases  of  women.  One  of 
these  is  the  prevalence  of  nutritional  and  functional  affections  of  the 
uterus  and  adnexa  readily  cured  in  this  way,  and  by  currents  easily 
made  effective  owing  to  an  insensitive  nerve-supply.  The  other  reason 
is  that  it  offers  a  choice  of  methods  in  a  class  of  affections  notoriously 
maltreated  at  present  by  methods  almost  invariably  involving  the 
sacrifice  of  organs. 

It  is,  of  course,  by  no  means  within  the  power  of  electro-gyne- 
cology  to  displace  the  really  necessary  work  accomplished  by  the 
modern  methods  of  aseptic  surgery,  but  it  is  within  its  province  to 
demonstrate  that  mutilating  and  sacrificial  operations  can  be  restricted 
to  cases  legitimately  requiring  such  measures  of  last  resort  by  reveal- 
ing the  curableness  of  many  affections  apparently  regarded  as  hope- 
less. The  extensive  prevalence  of  an  attitude  that  regards  the  removal 
of  an  organ  as  both  the  proper  and  the  only  way  to  cure  it  can  only  be 
regarded  as  the  sign  of  a  mental  epidemic  of  no  mean  proportions, 
particularly  when  such  attitude  is  maintained  only  toward  one  set  of 
organs. 

To  check  microbic  invasion  and  its  consequences,  remove  pain, 
restore  function,  correct  nutritional  faults,  check  hemorrhage,  cause 
retrogression  of  benign  growths,  and  restore  local  and  general  health 
is  a  sufficiently  broad  platform  for  a  single  agency,  and,  if  these,  or 
many  of  these,  results  can  be  accomplished  by  electricity  without 
danger,  risk,  or  mutilation,  its  claims  for  consideration  a-;  a  method 
of  choice  over  less  advantageous  procedures  are  imperative. 


28  DISEASES    OF    WOMEX. 

With  powers  so  conservative,  yet  vigorous,  at  command,  it  is 
clearly  the  duty  of  the  electro-gynecologist  to  protest  against  the  too 
common  practice  that  classes  gynecology  with  major  surgery  alone, 
and  results  in  sufferers  from  the  diseases  of  women  being  referred  at 
once  to  specialists  in  abdominal  surgery.  Xo  organ  should  be  sub- 
jected to  a  mutilating  operation,  certainly  none  removed  irom  the 
body,  until  the  powers  of  conservative  medication  have  been  intelli- 
gently tested;  yet  such  is  the  haste  in  the  performance  of  this  work 
of  last  resort  that  our  hospitals  particularly  have  become  the  sacri- 
ficial temples  of  this  new  faith,  in  which  women  by  the  score,  without 
previous  attempt  to  cure,  are  persuaded  to  undergo  operations  dan- 
gerous to  life  and  unwarranted  b}''  sound  judgment,  and  which  are 
followed  by  life-long  consequences  in  those  that  recover  that  are  either 
carefully  concealed  or  else  carelessly  withheld  from  their  knowledge 
before  their  consent  is  given. 

Special  Value  of  Electro-gynecic  Applications  to  the  General 
Practitioner. — Besides  the  opportunity  that  is  afforded  to  the  family 
physician  in  the  reference  of  his  more  difficult  cases  to  the  electro- 
gynecic  specialist  for  an  application  of  the  highest  skill  in  the  art  to 
a  truly  conservative  restoration  of  health,  a  mere  superficial  employ- 
ment of  this  agent  by  himself  is  calculated  to  be  of  immense  service 
to  his-patients  in  the  cure  of  many  deviations  of  function  which  may 
have  seemed  great  enough  to  demand  a  reference  to  others.  And  this 
large  field  of  usefulness  is  entirely  wanting  in  risk,  even  in  unaccus- 
tomed hands,  if  the  vaginal  methods  of  application  are  adhered  to  and 
the  intra-uterine  applications  withheld  until  greater  expertness  is 
gained. 

That  a  large  proportion  of  the  ordinary  cases  of  pelvic  pain 
and  discomfort  are  mainly  due  to  deficient  muscular  and  nervous  tone, 
to  relaxation,  to  the  consequences  of  sexual  excess,  and  to  congestions 
and  inflammatory  sequels  easily  removable  by  the  stimulant  and  tonic 
effects  of  vaginal  applications  of  the  faradic  current  is  well-known  to 
every  g}'necologist  who  sees  a  large  number  of  semi-acute  cases,  and 
there  is  no  reason  why  these  cases  should  not  be  treated  by  the  intelli- 
gent general  practitioner  with  an  office  practice,  particularly  when 
continued  delay  or  the  application  of  harsh  remedial  measures  will 
lead  to  an  intensification  of  the  trouble.  This  was  well  illustrated  by 
a  story  told  by  Dr.  Lapthorn  Smith,  of  Montreal,  who  had  recom- 
mended a  physician  to  purchase  a  faradic  apparatus,  and  on  calling 


ELECTIUCITY    AS    A    REMEDY.  29 

at  his  oflice  some  time  subsequently  was  surprised  at  its  worn  condi- 
tion. The  physician  explained  matters  by  asserting  that  he  had  cured 
a  considerable  number  of  cases  by  its  use.  Asked  what  had  been  the 
matter  with  the  patients,  he  could  only  reply  that  he  did  not  know, 
but  that  they  had  been  cured,  nevertheless.  The  interests  of  exact 
science  condemn  such  blind  empiricism  and  routinism,  but,  when  it 
is  remembered  that  the  remedy  employed  by  him  is  incapable  of 
harm,  no  one  can  say  that  this  physician  was  wanting  in  either  com- 
mon sense  or  humanitarian  principles. 

Limitations. — An  attempt  to  assign  exact  limits  to  the  medical 
usefulness  of  an  agency  such  as  electricity  will  remain  impossible  for 
some  time,  owing  to  the  varied  nature  of  the  conditions  attending  its 
employment.  One  may  believe,  for  instance,  that  ergot,  iodine,  or 
other  material  agent  may  be  thus  easily  understood,  but  the  agent,  in 
this  case,  being  the  intensification  or  alteration  of  the  molecular  activi- 
ties in  a  controllable  maimer,  with  immediate  results  varying  through 
an  enormous  range  of  current-strengths  and  qualities,  the  field  of  use- 
fulness is  more  widely  varied,  and  it  is  probable  that  conditions  yet 
regarded  as  incurable  in  this  way  may  merely  require  a  heavier  or 
more  skillfully  applied  current.  It  is  true,  nevertheless,  that  many 
limitations  to  its  usefulness  are  at  present  apparent,  in  the  discovery 
of  which  a  large  and  constantly  increasing  list  of  valuable  uses  has 
been  established. 

No  claims  that  electricity,  or,  in  fact,  anything  else,  is  a  cure-all 
is  possible  to  the  scientific  mind,  and,  although  these  pages  are  largely 
devoted  to  a  demonstration  of  its  value  in  the  definite  conditions 
enumerated,  it  is  not  supposed  that  the  reader  is  to  neglect  any  simpler 
means  that  would  be  effective  in  the  treatment  of  his  cases;  for  ap- 
proved medical  treatment,  including  the  use  of  internal  remedies  or 
of  applications  capable  of  being  administered  by  the  patient,  are 
always  preferable  to  remedial  means  that  require  the  physician's  per- 
sonal attention,  provided  the  same  ends  can  be  accomplished. 

A  similar  discretion  is  also  assumed  upon  the  part  of  the  reader 
in  the  -'loice  between  electricity  and  the  knife,  the  former  being  ad- 
vised only  when  it  is  equally  certain  in  effect,  free  from  danger,  and 
more  conservative  of  organs  and  their  functions;  and,  unless  experi- 
ence shows  us  that  all  or  most  of  these  advantages  are  assured  as  a 
result  of  the  electric  treatment  of  a  particular  case,  we  should  not 
lose  time  by  its  employment.     It  should  not  be  forgotten,  neverthe- 


30  DISEASES    OF    WOMEN. 

less,  that  in  case  of  uncertainty  on  theso-  points  a  course  of  electric 
treatment  is  incapable  of  doing  harm,  and,  in  the  event  of  failure, 
leaves  the  patient  in  a  position  to  derive  full  benefits  from  surgical 
treatment,  which  cannot  be  sai  T  conversely  of  patients  vho  have  failed 
of  relief  under  a  surgical  operation. 


CHAPTEE  IV. 

Phenomena  Attending  the  Transmission  of  Galvanic 
Querents  Through  Living  Organs. 

Physical  Reasons  for  Electrode  Coverings. — With  low-pressure 
currents,  such  as  the  galvanic  and  faradic,  it  is  essential  that  a  good 
contact  be  made  between  any  two  parts  of  the  circuit,  since  these  cur- 
rents have  very  slight  power  to  jump  through  the  air.  In  the  human 
body  the  moist  tissues  are  the  conductors,  which,  in  percutaneous 
applications,  we  find  surrounded  by  an  insulating  envelope  of  dry 
cuticle,  presenting,  together  with  the  slight  layer  of  air  between  it  and 
the  dry  metallic-electrode  surface,  a  very  large  amount  of  resistance. 
One  important  purpose  of  an  electrode  covering  is  the  maintenance  of 
a  moist  conducting-joint  between  this  metallic  surface  and  the  moist, 
subdermic  tissue,  the  water  contained  in  the  covering  not  only  blotting 
out  the  air-cushion  beneath  the  electrode,  but  rendering  the  cuticle 
itself  a  better  conductor  by  soaking  it.  It  is  true  that  a  little  current 
will  be  apt  to  pass  from  a  dry  metallic  surface  to  the  body  with  cur- 
rents of  a  pressure  of  50  or  100  volts  (such  as  with  the  galvani-  brush), 
but  the  lines  of  potential  will  be  almost  exclusively  within  the  skin 
rather  than  beneath  it.  In  other  words,  the  energy  of  the  current 
will  be  mostly  expended  here,  making  the  application  practically  one 
to  the  skin  only  (see  Experiment  5,  page  313).  Deep  penetration  of 
the  current  is  then  a  prime  reason  for  a  well-moistened  electrode 
covering,  with  the  associated  fact  of  a  minimum  of  dermic  action  and 
pain.  Another  important  use  is  the  protection  of  the  surface  from 
certain  chemic  and  electrolytic  polar  effects  when  they  are  not  desired. 
When  we  wish  to  make  use  of  these  effects  to  their  fullest  extent  pro- 
vision is  made  for  an  immediate  contact  between  the  metal  and  moist 
tissue,  as  by  puncture  through  the  skin  or  by  simple  contact  if  it  be 
a  mucous  surface. 

Moist  absorbent  cotton,  which  was  first  recommended  by  the 
author  as  an  electrode  covering  in  1885,  remains,  in  his  opinion,  the 
most  cleanly,  easily  applied  and  renewed,  and  generally  useful  material 

(31) 


32 


DISEASES    OF    WOMEN. 


for  this  purpose,  the  accuracy  of  its  contact  with  the  skin  being,  how- 
ever, greatly  increased  by  thoroughly  soaping  its  surface.  In  1883 
Apostoli  introduced  well-moistened  sculptors'  clay  as  the  material  for 


Fig.  13. — Applying  absorbent  cotton  to  electrode  disk   (first  stage). 

the  large  abdominal  pad  when  it  is  desired  to  render  one  pole  non- 
active,  or  capable  of  transmitting  a  large  current  with  a  minimum 
of  sensation  and  local  resistance  at  this  spot.    If  thoroughly  adhesive 


Fig.  14. — Applying  absorbent  cotton  to  electrode  disk   (second  stage). 


it  has  an  advantage  possessed  by  no  other  material  in  accuracy  of  con- 
tact, which  practically  broadens  the  path  through  the  skin.* 

Cnrrent-diffusioii  Within  the  Body. — The  subdermic  body  con- 
ducts currents  with  a  reasonable  ease  because  of  its  watery  and  saline 


TRANSMISSION    OF    GALVANIC    CURRENTS,  33 

constituents.  Grossly  speaking,  those  parts  that  are  most  watery  are, 
therefore,  the  chosen  paths  of  transit  througli  the  body,  a  greater 
proportion  of  current  going  througli  the  soft  tissues  around  bones  and 
nerves  than  will  take  the  apparently  shorter  cut  through  them.  Such 
considerations  are  important  when  we  are  compelled  to  depend  upon 
interpolar  action  for  therapeutic  effect,  and  desire  to  send  a  dense 
current  through  a  region  beyond  immediate  contact  with  the  electrode. 
Of  still  greater  importance  is  a  clear  idea  of  current-diffusion  in  the 
body  as  a  whole.  To  suppose  that  we  can  send  a  current  through  the 
body  like  a  straight  beam  of  light,  or  even  in  the  bellied  cylinders  de- 
picted by  Erb,  is  to  ignore  well-known  laws  of  resistance  and  current- 
diffusion.  The  author  pointed  out  some  years  ago^  that  a  demonstra- 
tion of  the  real  facts  of  much  importance  to  physicians  is  contained 
in  Prof.  W.  G.  Adams's  experimental  measurements  of  current-diffu- 
sion within  masses  of  salt  water.^  Buckets  and  tubs  of  salt  water  and 
various  acid  solutions  were  used  fov  experiments,  the  character  of  the 
solutions  and  the  shapes  of  the  utensils  presenting  conditions  closely 
analogous  to  the  human  body.  To  illustrate  the  facts  thus  verified,  I 
have  drawn  three  diagrams  (Figs.  15,  16,  and  17)  in  which  the  be- 
havior of  a  current  traversing  narrow  and  wide  conductors  is  shown. 
The  lines  of  flow  are  seen  in  each  instance  to  cross  the  dotted  lines  at 
right  angles.  These  dotted  lines  are  lines  of  equal  potential.  Exactly 
what  equipotential  lines  in  electricity  are  can  be  best  understood  when 
it  is  known  that  they  are  analogous  to  the  edges  of  the  steps  of  a  stair- 
case down  which  a  water-current  is  flowing.  In  this  case  it  is  assumed 
that  the  middle  step  is  zero,  or  at  the  level  of  the  earth  (making  it 
analogous  to  a  staircase  Avith  the  middle  step  at  street-level,  and  each 
half  of  the  remainder  going  upstairs  and  down  cellar). 

In  the  narrow  conductor  (Fig.  15)  the  equipotential  lines,  or,  in 
illustrative  language,  the  edges  of  these  steps  of  electric  level,  extend 
straight  across  the  conductor,  the  lines  of  flow  being  straight  lines 
from  pole  to  pole.  In  the  wider  conductor  (Fig.  16)  the  lines  of 
potential  tend  to  curve  somewhat  about  the  poles;  hence  the  lines 
of  flow  on  either  side  of  the  centre  one,  which  remains  straight,  curve 
a  little  also,  as  the  potential  lines  must  be  crossed  at  right  angles. 


'  Journal  Nervous  and  Mental  Disease,  No.  7,  1886. 

^  Proc.  Eoyal  Society,  vol.  xxiv,  p.  1.     See,  also,  a  theoretical  discussion 
by  Foster  and  Lodge,  Proc.  Lond.  Phys.  Soc,  vol.  i,  page  113. 

8 


34 


DISEASES    OF    WOMEN. 


When  the  current  is  passed  through  so  large  a  conductor  as  tiie 
human  body  (Fig.  17),  the  potential  lines  become  arcs  of  small  circles 
about  each  pole,  the  size  of  the  circles  rapidly  increasing  as  we  pro- 
ceed away  from  the  poles.  The  lines  of  flow  traverse  every  portion  of 
the  conductor  as  before,  crossing  the  equipotential  lines  at  right 


Fig.  15. — Diagram  showing  the  distribution  of  a  current  of  twenty 
volts  within  a  narrow  conductor.  The  milliamperes  are  equally  distributed 
in  the  lines  of  flow  (represented  in  the  cut  by  horizontal  lines).  The  lines 
of  equal  potential  (represented  by  dotted  lines)  are  drawn  one  volt  apart, 
and  have  a  value  indicated  bv  the  figures. 


angles,  and  differ  in  amount  of  current  carried  only  in  inverse  ratio 
to  their  length. 

It  is  necessary  to  add  that  these  diagrams  represent  the  distri- 
bution in  an  homogeneous  conductor,  such  as  a  single  organ,  and  that 
slight  alterations  would  be  required  to  make  them  represent  accu- 
rately any  composite  conductor  like  the  body.  An  accurate  chart  of 
the  soft  parts,  nevertheless,  would  only  add  waviness  to  the  lines  as 


Fig.  16. — Distribution  of  a  current  of  twenty  volts  within  a  wider  conductor. 

The  lines  of  flow  on  either  side  of  the  central  one  curve  somewhat, 

as  do  also  the  most  positive  and  most  negative  potentials. 


drawn,  though  bones  and  bony  cavities  would  deflect  them  greatly. 
It  should  also  be  romembererl  that  the  diagrams  represent  a  section 
only,  and  that  the  equipotential  lines  are,  in  reality,  cup-shaped  planes 
through  which  the  lines  of  flow  snread  in  all  directions. 


TRANSMISSION    OF    GALVANIC    CURRENTS. 


35 


Current-concentration. — It  is  the  converse  of  these  facts  of  cur- 
rent-diffusion within  the  body  that  it  is  difficult  or  impossible  to 
bring  a  concentrated  current  to  bear  on  organs  or  growths  that  are 
far  beneath  the  surface,  the  nearest  approach  to  concentration  at  a 
distance  requiring  a  very  heavy  current  at  the  polar  contacts.  Now, 
the  effects  are  proportional  to  the  concentration  as  well  as  to  the 
strength  of  the  current;  that  is,  10  milliamperes  will  act  with  twice 


I         0 


■/  2 


Fig.  17. — Distribution  of  a  current  of  twenty  volts  within  the  liuman 
body.  The  equipotential  lines  or  planes  become  segments  of  perfect  circles, 
and  the  lines  of  flow,  necessarily  crossing  the  latter  at  right  angles,  become 
greatly  curved  and  extend  to  all  parts  of  the  body  in  passing  from  pole  to 
pole.  The  number  of  milliamperes  traversing  the  lines  of  flow  difi"ers  some- 
w'hat,  being  inversely  proportional  to  the  length  of  the  lines. 


the  strength  on  a  surface  of  one  centimetre  that  it  will  on  two  centi- 
metres; hence  the  field  of  application  of  concentrated  currents  is  far 
greater  in  what  is  called  the  polar  regions,  or  in  the  immediate  neigh- 
borhood of  the  poles,  than  in  any  other  portion  of  the  circuit. 

It  will  be  noted  also,  by  a  reference  to  the  cuts,  that  in  a  large 
conductor  such  as  the  body  the  current  will  so  spread  out  after  enter- 
ing it  that  it  cannot  be  said  to  traverse  a  nerve  or  other  structure 
beneath  the  pole  in  any  special  direction,  since  it  traverses  it,  in  fact, 


36  DISEASES    OF    WOMEN. 

in  every  direction.  These  considerations,  together  with  important 
electrolytic  and  cataphoric  actions  at  each  pole,  result  In  making  a 
galvanic  application  practically  an  application  to  an  organ  of  a  certain 
polarity  to  a  variable  surface  and  depth. 

At  the  surface  itself  the  effects  can  be  accurately  gauged  by  a 
combination  of  the  three  elements  of  strength,  duration,  and  concen- 
tration, the  cauterant  effects  to  be  described  later  being  particularly 
dependent  on  the  polar  concentration,  which  is  determined,  in  appli- 
cations to  mucous  surfaces,  by  the  extent  of  the  electrode  left  un- 
covered by  insulation.  With  an  intra-uterine  electrode,  for  instance, 
having  a  bare  surface  extending  two  inches  back  from  the  point,  20 
milliamperes  may  not  cauterize  in  three  minutes,  but  may  cauterize 
slightly  in  five.  Fifty  milliamperes  can  be  used  with  a  bare  electrode 
of  greater  size  in  the  vagina  under  the  same  conditions,  with  about 
the  same  result.  On  the  -other  hand,  ^  to  1  milliampere,  applied  on 
the  point  of  a  fine  needle,  as  in  the  epilation  of  hairs,  will  cauterize 
in  a  few  seconds. 

Polar  Regions. — The  area  beneath  each  electrode,  or  around  it 
if  placed  within  the  body,  where  the  current-lines  are  densest  and  the 
polarity  most  positive  or  negative,  is  called  the  polar  region,  the  inter- 
vening space  being  interpolar.  Besides  the  results  due  to  the  usual 
concentration  at  the  polar  regions,  certain  chemic  and  vital  effects 
noted  below  appear  in  these  regions  only,  rendering  them  the  most 
effective  situations  for  electric  application.  Yet  a  diminishing  polar- 
ization extends  deeply  into  the  body  from  a  strong  current,  being  nil 
only  in  the  centre,  and  the  lines  of  flow,  though  greatly  dispersed  at 
this  depth,  extend  completely  through  the  body.  This  intermediate 
region  is  called  the  interpolar  region  (Fig.  18). 

Within  the  interpolar  region  the  interstitial  and  cellular  irrita- 
tion incidental  to  the  transmission  of  the  current  and  of  the  particles 
that  appear  naked  at  the  poles  is  the  chief  basis  for  therapeutic  re- 
sults, while  in  the  polar  regions  the  chemic  action  of  these  particles, 
as  described  below,  is  supplemented  by  another  set  of  phenomena  due 
to  the  behavior  of  nerves  when  under  the  influence  of  concentrated 
current  at  either  pole.  It  is  in  the  immediate  vicinity  of  the  poles, 
therefore,  that  the  most  direct  therapeutic  results  are  obtained,  and 
the  readiness  with  which  electrodes  may  be  brought  in  contact  with 
diseased  conditions  within  the  pelvis  is  a  most  promising  fact  for  the 
electro-therapeutics  of  gynecology,  although,  even  in  this  class  of  dis- 


TRANSMISSION  OF  GALVANIC  CURRENTS. 


37 


eases,  the  interpolar  action  of  the  current  must  frequently  be  depended 
upon. 

It  is  hardly  necessary  to  mention  here  that  no  attention  is  paid 
to  the  direction  of  the  current,  as  such,  by  modern  therapeutists,  who 
look  only  to  the  polarity  of  the  active  electrode.  The  older  terms 
"ascending"  and  "descending"  were  incorrect  in  view  of  the  fact  that 
a  current  spreads  in  all  directions  beneath  each  pole;  and  the  reac- 
tions formerly  attributed  to  one  or  the  other  direction  are  now  known 


Fig.  18. — Diagram  of  polar  and  interpolar  regions.  The  current  lines 
are  drawn  full  in  the  polar  regions  and  dotted  in  the  interpolar  region. 
The  active  polar  region,  which  is  negative  in  the  cut,  extends  in  all  direc- 
tions around  the  electrode,  but  is  widest  on  the  aspect  nearest  to  the  in- 
different pole. 


to  be  due  to  the  polarity.  Even  within  the  interpolar  region  the  direc- 
tion of  the  current  has  no  known  significance  at  present. 

It  should  also  be  understood  that  the  region  of  nerve-polarization 
about  an  active  pole  is  somewhat  larger  than  the  region  of  chemic 
decomposition,  and  that  we  can  readily  include  Avithin  it  any  nerve 
or  nerves  within,  say,  three-fourths  of  an  inch  of  the  electrode,  when 
using  currents  of  20  or  30  milliamperes. 

The  Interpolar  Region. — Since  it  follows,  from  the  facts  touched 


38  DISEASES    OF    WOMEN. 

upon  in  the  foregoing  paragraphs,  that  the  chemically  destructive 
action  of  a  continuous  current  is  limited  to  the  close  neighhorhood 
of  the  electrodes,  and  the  direct  nerve-modifying  action  is  also  limited 
to  a  somewhat  larger  region  in  the  same  situation,  the  natural  ques- 
tion arises:  What  can  be  therapeutically  accomplished  when  the  seat 
of  disease  is  necessarily  situated  beyond  the  direct  reach  of  the  elec- 
trode? An  answer  drawn  from  both  neurologic  and  gynecic  expe- 
rience is  that  much  can  be  accomplished;  and  this  is  doubtless  due, 
in  the  first  place,  to  the  influence  upon  nutrition  of  the  chemic  inter- 
changes that  occur  throughout  the  circuit,  in  the  onward  progress  of 
the  particles  that  appear  free  finally  at  the  poles  (cataphoresis),  to  the 
influence  upon  nutrition  of  the  circulatory  changes  that  result  from 
vasomotor  stimulation,  and  to  the  contractions  produced  in  unstriated 
muscular  tissue  by  heavy  currents,  even  at  a  distance. 

These  results  of  quiet  current  transmission  are  governed  in  mag- 
nitude at  a  given  spot  by  the  density  of  the  current  at  that  situation 
and  by  the  duration  of  the  application.  The  difficulty  of  carrying  an 
effective  density  to  a  tumor,  extravasation,  or  other  morbid  spot,  situ- 
ated at  some  distance  from  the  active  electrode,  is  indicated  by  a 
glance  at  Fig.  18,  in  which  the  spread  of  current  is  well  represented 
by  the  direction  and  shading  of  the  lines  shown  in  the  interpolar 
region. 

To  accomplish  much  in  the  more  distant  parts  of  this  region  con- 
siderable milliampere-strength  must  be  employed;  hence  a  delicate 
judgment  is  demanded  in  the  selection  of  the  size  of  the  active  pole 
to  avoid  cauterization,  on  the  one  hand,  and  too  great  a  diffusion,  on 
the  other. 

Electrolysis. — A  current  from  a  battery  of  cells  is  an  instance  of 
chemic  energy  converted  into  electric  energy.^  The  correlation  of 
forces  in  nature  is  evidenced  by  the  fact  that  this  electric  energy  may 
be  reconverted  into  chemic  energy  when  a  current  is  made  to  traverse 
a  watery  solution  of  salts  and  other  binary  compounds,  the  compounds 
being  decomposed  into  their  ultimate  elements  by  a  process  called 
"electrolysis."  All  liquids  that  conduct  electricity,  except  mercury 
and  melted  metals,  are  thus  decomposed  by  its  passage  through  them, 
the  accepted  explanation  being  that,  of  any  two  atoms  forming  a 


'  Which   is  ultimately  true  also  in  dynamo-produced   currents,  in   which 
the  energy  may  be  traced  hack  to  the  chemic  energy  of  the  coal  consumed 


TRANSMISSION    OF    GALVANIC    CURRENTS.  39 

binary  compound,  one  is  positive  and  the  other  negative,  and  that 
when  an  electric  current  is  passed  through  the  solution  the  electric 
affinity  becomes  superior  to  the  chemic  affinity^  and  tears  them  apart, 
the  freed  elements  being  called  "anions"  and  "cations." 

Water,  though  when  absolutely  pure  a  non-conductor  of  elec- 
tricity, in  its  ordinary  state  contains  sufficient  saline  impurities  for 
conduction,  and  is  then  readily  electrolyzed  into  its  component  atoms 
of  oxygen  and  hydrogen,  the  oxygen  becoming  an  anion  and  going  to 
the  positive  pole,  or  anode,  and  the  hydrogen,  a  cation,  and  appearing 
at  the  negative  pole,  or  cathode  (Fig.  19).  At  the  point  of  contact  of 
the  positive  electrode  with  the  water  the  oxygen  contained  within  the 
nearest  molecules  is  torn  from  the  hydrogen  and  attracted  to  the  elec- 
trode; the  freed  hydrogen-atoms  immediately  attach  themselves  to 


•o  •O  #0  #0  •O  #0  oo 
•   o»c»o»o»o#o»o»o 

•O«O«D«0«O«D<O«0 

-<i 


Fig.  19. — Diagram  of  electrolysis.  The  electro-positive  radicle  of  each 
molecule  is  represented  black,  and  becomes  a  cation  when  released  at  the 
cathode,  or  negative  pole.  The  electro-negative  radicles  are  drawn  white, 
and  become  anions  \\hen  released  at  the  anode,  or  positive  pole. 

more  distant  oxygen-atoms,  freeing  other  hydrogen-atoms  nearer  the 
negative  pole,  which  repeat  the  process  with  the  next  molecules.  In 
this  w^ay  a  chain,  or  series,  of  electric  transferences  occurs  throughout 
the  circuit,  the  last  hydrogen-atom  remaining  free  and  attracted  to 
the  negative  pole,  to  which  it  adheres.  Thus  a  double  process  of 
actual  and  physical  transference  occurs  in  opposite  directions,  the 
amounts  being  equal  and  proportional  to  the  milliamperes  used,  the 
electrolytic  transference  differing  from  cataphoric  transference  in 
that  the  latter  may  occur  without  chemic  absorption  of  the  propelled 
bodies  at  any  portion  of  the  circuit. 


^  Chemic  affinity  is  now  understood  to  be  identical  with  electric  affinity, 
the  atoms  of  a  binary  compound  being  held  together  by  the  attraction  of  their 
opposite  charges. 


40  DISEASES    OF    WOMEN. 

That  the  electrolytic  combinations  and  recombinations  in  the 
interpolar  portions  of  the  circuit  may  exert  profound  effect  on  the 
metabolic  activities  of  the  tissues  is  certain,  yet  the  most  apparent 
physical  effects  are  found  in  the  immediate  polar  regions,  both  on 
account  of  the  usual  concentration  of  current  in  this  situation  and  of 
the  action  of  the  freed  anions  and  cations,  which,  being  in  their 
nascent  condition,  produce  effects  due  to  their  union  with  the  tissues. 
The  polar  effects  are,  therefore,  peculiar  to  each  pole  and  are  of  pre- 
dominant therapeutic  interest. 

Cliemic  Effects  at  Each  Pole. — Though,  as  has  been  said,  the 
electrolysis  extends  throughout  the  electrolyte  and  occurs  in  any  por- 
tion of  it  in  proportion  to  the  strength  of  the  lines  of  flow  that  trav- 
erse that  portion,  the  freed  elements,  anions  and  cations,  appear  only 
at  the  poles,  or  electrodes.  In  the  body,  constituted  so  largely  of 
water  and  various  salines  in  solution,  the  anions  that  appear  at  the 
positive  pole  are  oxygen,  chlorine,  and  the  acids,  and  the  cations  at  the 
negative  pole  are  hydrogen  and  the  bases.  When  released  in  suffi- 
cient quantity  the  caustic  effects  are  characteristic  at  each  pole,  and 
have  been  specially  applied  to  therapeutics  by  Tripier  and  Apostoli 
under  the  name  of  "galvano-chemic  cauterization." 

Since  the  gj^necic  applications  of  electricity  consist  frequently  of 
sufficient  milliamperes  and  concentration  to  produce  these  local 
effects,  their  exact  nature  invites  close  study.  A  careful  naked-eye 
observation  of  the  phenomena  when  a  strong  current  is  flowing  is 
certainly  both  instructive  and  impressive,  as  well  as  decidedly  con- 
ducive to  the  future  welfare  of  the  observer's  patients.  An  experi- 
ment with  fresh  butchers'  meat  will  give  a  very  good  illustration  of 
the  chemic  part  of  these  phenomena  as  they  occur  within  the  living 
body. 

Experiment  \} — Procure  a  half-pound  of  beef-muscle;  insert  into 
it  two  ordinary  steel  needles,  one  connected  with  the  positive  pole  and 
the  other  with  the  negative  pole  of  a  good  battery,  and  pass  through 
the  meat  from  100  to  200  milliamperes  for  two  minutes. 

A  sort  of  hissing  or  frying  noise  will  be  heard.  This  is  seen  to 
be  caused  by  the  rapid  production  and  escape  of  small  bubbles  (of 
hydrogen-gas)  from  the  track  of  the  negative  needle.  The  positive 
needle  will  cause  no  appreciable  production  of  gas,  but  will  imme- 


'  For  further  experiments  \\  itli  currents  see  page  312. 


TRANSMISSION    OF    GALVANIC    CUERENTS.  41 

diately  be  found  to  be  so  firmly  fixed  in  the  tissues  as  to  be  with- 
drawable with  difficulty. 

On  cutting  down  alongside  the  negative  needle  it  is  found  to  be 
practically  surrounded  by  a  cavity  containing  liquids  and  bubbles  of 
hydrogen-gas.  The  muscular  tissue  has  been  destroyed  wherever  in 
contact  with  the  needle,  the  edges  of  the  cavity  showing  it  softened, 
infiltrated,  and  of  a  darker  color.  The  needle  remains  as  bright  as 
ever. 

The  positive  needle,  if  left  in  place  and  cut  down  upon,  shows 
itself  greatly  rusted  and  corroded,  inclosed  firmly  in  a  grayish  eschar, 
colored  darker  in  places  by  the  dissolved  iron  of  the  needle. 

If  the  positive  needle  be  of  brass,  copper,  nickel,  zinc,  aluminum, 
or  any  of  the  other  baser  metals,  it  is  corroded  with  varying  rapidity, 
the  tissues  being  stained  by  the  particular  metallic  salts  formed  for 
some  distance  from  the  needle.  On  using  a  platinum  needle  for  the 
positive  pole,  on  the  contrary,  it  is  found  to  be  practically  unattacked 
by  the  nascent  oxygen  and  acids.  The  tissues  about  the  needle  show 
now  the  uncomplicated  picture  of  a  positive  electrolysis, — ^viz.,  the 
characteristic  hardening  and  searing  of  an  acid  application.  A  slight 
cavity  forms  about  the  needle,  though  not  so  large  as  that  about  the 
negative  needle,  filled  with  bubbles  of  oxygen-gas  which  have  failed  to 
unite  with  the  platinum,  and  the  non-corrodible  positive  needle  is 
therefore  not  so  firmly  fixed  in  the  tissues  as  would  happen  with  a 
baser  metal.  This  refractoriness  of  platinum  is  shared  in  a-  lessened 
degree  by  gold  and  carbon,  the  former  being  corroded  to  a  slight 
extent  and  the  latter  roughened  slightly  in  time  by  mechanical  dis- 
integration. It  is  evident,  therefore,  that,  whenever  the  active  pole  of 
a  strong,  concentrated  current  is  positive,  it  should  consist  of  either 
platinum,  gold,  or  carbon,  unless  we  wish  to  employ  cataphoric  diffusion 
of  the  material  of  the  electrode. 

The  negative  needle  remains  clean,  whatever  the  metal  of  which 
it  is  composed  or  the  strength  of  the  current. 

Eeverting  to  the  disintegrated  cavities  in  the  meat,  produced  by 
the  negative  and  positive  poles  of  a  strong  current  (the  positive  pole 
having  been  non-corrodible),  we  can  easily  prove  that  the  froth  at  the 
negative  is  alkaline,  and  that  at  the  positive  acid,  by  placing  a  drop 
of  litmus  solution  upon  each  and  allowing  the  current  to  continue 
a  few  moments.  The  blue  color  of  the  solution  is  unchanged  at  the 
negative  pole,  but  is  quickly  reddened  at  the  positive.     By  changing 


42  DISEASES    OF    WOMEN. 

the  character  of  the  pole  back  and  forth  while  still  in  situ,  several 
such  changes  of  color  can  be  produced.  The  peculiarities  of  the  dis- 
integrating action  of  each  pole  are  largely  due  to  the  nascent  alkalies 
of  one  and  the  nascent  acids  of  the  other.  At  the  negative  pole  we 
have  the  soft  liquefaction  and  infiltrated  edges  of  an  alkaline  caustic; 
at  the  positive  pole  the  hardened,  coagulated  eschar  of  an  acid  caustic. 

Extent  of  Destruction  at  the  Poles. — As  to  the  extent  of  the 
destruction  produced  by  a  current, — a  question  of  great  interest  in  the 
treatment  of  tumors  and  other  structures  beyond  the  range  of  vision, 
— I  have  made  the  rough  estimate  that  200  milliamperes,  concen- 
trated at  the  half-inch  exposed  end  of  a  negative  needle,  will  destroy 
an  area  of  this  length  and  a  quarter  of  an  inch  in  diameter  in  the 
muscular  tissue  of  the  cadaver,  if  passed  through  for  two  minutes. 
In  a  living  carcinomatous  tumor  of  the  breast  I  have  produced  a 
necrotic  area  about  two  inches  broad  by  one  inch  in  depth  by  1000  mil- 
liamperes in  ten  minutes. 

The  amount  of  destruction  produced  by  the  same  number  of 
milliamperes  in  diiTerent  tissues  varies,  though,  and  it  may  be  said  to 
depend  largely  on  the  aqueous  contents  of  the  tissue,  for  the  cavities 
produced  in  the  experiments  on  meat  were  caused,  to  a  large  extent, 
by  the  destruction  of  water.  Less  decomposition  will  be  attained  by 
the  same  current  in  a  fibroma  than  in  a  striated  muscle,  for  this 
reason,  and  the  disintegration  depends  more  largely  on  the  cauteriz- 
ing effects  of  the  liberated  chemicals,  though  necrosis  does  not  occur 
at  this  pole  even  with  this  current-strength  if  the  electrode  be  of  gold 
freely  supplied  with  a  coating  of  mercury  for  the  oxygen  and  chlorine 
to  attack. 

Cataphoresis. — But  there  is  another  physical  accompaniment  of 
the  transmission  of  galvanic  currents  through  a  liquid-containing  con- 
ductor, such  as  the  body,  and  that  is  the  actual  transfer  of  liquids 
and  solids  (in  solution  or  in  small  particles)  through  it  in  the  direction 
of  the  current.  This  is  analogous  to  ordinary  osmosis,  but  is  entirely 
determined  in  direction  and  amount  by  the  current.  It  is  called 
cataphoresis,  and,  since  medicaments  can  be  inserted  into  the  body  by 
it,  chiefly  from  the  anode,  or  positive  pole,  it  has  also  been  termed 
"anodal  diffusion"  by  Peterson,  of  New  York,  who  has  made  a  recent 
study  of  the  subject.  It  may  be  demonstrated  in  physical  apparatus 
by  inserting  an  electrode  each  into  two  porous  cups  that  have  been 
filled  to  the  same  height  with  water  and  placed  in  a  pan  of  water  of 


TKANSMISSION  OF  GALVANIC  QUERENTS.  43 

the  same  depth.  After  the  current  has  passed  for  a  time  it  will  be 
noticed  that  the  level  of  the  water  in  the  tube  in  which  the  positive 
pole  has  been  placed  is  lower,  while  that  in  the  negative  tube  is  dis- 
tinctly higher,  showing  an  actual  transfer  of  the  liquid. 

The  same  action  is  easily  demonstrated  in  the  living  subject  dur- 
ing the  course  of  a  vaginal  application,  such  as  will  be  described  later, 
if  the  cotton  covering  of  the  vaginal  electrode  is  not  abundantly 
saturated  with  water  before  insertion.  If  it  is  made  positive  under 
such  circumstances  and  50  milliamperes  turned  on,  it  is  extremely 
probable  that  the  current  will  shortly  decrease  on  account  of  actual 
drying  of  the  layer  of  cotton  in  immediate  contact  with  the  metal, 
rendering  the  resistance  greater  in  that  situation.  I  have  seen  it 
decrease  to  30  or  20  milliamperes  in  a  few  minutes,  the  moisture  hav- 
ing been  passed  onward  into  the  tissues.  If  now,  before  actual  drying 
of  the  cotton  has  occurred,  the  current  be  turned  off,  the  commutator 
changed  to  make  the  internal  electrode  negative,  and  the  current 
again  turned  on,  the  ease  with  which  the  battery  will  supply  50  milli- 
amperes will  be  in  striking  contrast  to  the  difficulty  when  the  active 
electrode  was  positive.  In  a  few  moments  the  returning  moisture 
of  the  cotton  Avill  admonish  us  to  turn  the  controller  back,  or  more 
current  will  pass  through  than  was  desired.  The  desiccating  effect 
of  the  positive  pole  is  so  great  that  when  concentrated,  as  in  puncture 
with  a  fine  needle,  it  is  often  difficult  to  get  sufficient  current  without 
increasing  the  electromotive  force,  while  no  such  trouble  occurs  if 
the  puncture  is  negative. 

This  desiccating  action  of  the  positive  pole  renders  it  of  value 
in  lessening  congestion  and  checking  hemorrhage,  while  the  congest- 
ing effect  of  the  negative  pole  renders  assistance  in  impaired  nutri- 
tion, in  dilating  orifices  and  canals,  and  in  promoting  flow  or  drainage. 

It  has  been  seen  that  the  metal  of  which  the  positive  pole  is  com- 
posed is  a  matter  of  importance,  since,  if  not  platinum  or  carbon, 
it  is  attacked  by  the  nascent  anions  released  in  contact  with  it,  par- 
ticularly oxygen  and  chlorine.  Iron,  lead,  zinc,  brass,  and  copper 
are  easily  and  deeply  corroded  in  this  way;  tin,  silver  and  alumi- 
num less  readily,  but  distinctly,  acted  upon;  and  even  gold  is  rough- 
ened and  its  alloys  oxidized  after  a  time.  Carbon  resists  any  direct 
action  apparently,  yet  a  carbon  electrode  in  continual  use  as  a  posi- 
tive pole  soon  becomes  roughened,  apparently  by  a  detachment  of 
the  looser  particles  on  its  surface,  but  possibly  by  the  direct  action 


•i-i  DISEASES    OF    WOMEN. 

of  the  oxygen.  Platinum  alone,  and  its  more  rigid  alloy  with  iridium, 
seems  to  be  the  only  metal  absolutely  proof  against  the  intense  chemic 
activities  concentrated  at  the  positive  pole  of  a  strong  current. 

When  one  of  the  baser  metals  is  placed  within  or  in  contact  with 
the  body  as  a  positive  pole  an  oxychloride  is  formed  which,  by  an 
electrolytic  cataphoresis,  is  transmitted  through  the  body  toward  the 
opposite  pole.  That  is,  it  unites  with  the  tissues  in  immediate  con- 
tact with  the  electrode  surface,  while  being  transmitted  inward,  if 
the  electrode  has  no  covering  of  clay  or  cotton,  and  by  chemic  action 
produces  the  characteristic  effect  of  the  nascent  substance  on  flesh 
if  the  current  is  strong  and  sufficiently  concentrated.  Platinum  and 
carbon  anodes  therefore  enable  us  to  produce,  when  the  current  is 
strong  and  concentrated,  a  caustic  action  due  to  nascent  oxygen  and 
chlorine  alone,  while  the  baser  metallic  anodes  add  the  effect  due  to 
caustic  salts  of  the  metal  employed,  and  their  use  also  involves  a  cata- 
phoric transmission  of  the  metal  into  the  body  if  no  electrode  cover- 
ing is  used.  "With  or  without  an  electrode  covering,  and  whether 
concentrated  or  dispersed  by  varied  sizes  of  electrodes,  an  amount  of 
metal  is  always  dissolved  from  the  anode,  or  positive  pole,  of  a  base 
metal  in  exact  proportion  to  the  millicoulombs  used. 

Besides  the  depleting  and  congesting  actions  of  the  two  poles 
already  alluded  to,  it  will  be  seen,  therefore,  that  important  use  may 
be  made  of  metallic  cataphoresis,  if  desired,  by  using  the  metal  as  an 
uncovered  anode.  This  subject  has  been  elaborated  by  Gautier, 
Morton,  Goelet,  and  Cleaves,  and,  in  addition  to  the  following  descrip- 
tion of  the  modus  operandi,  its  application  in  special  classes  of  cases 
will  be  dwelt  upon  in  the  chapters  devoted  to  special  therapeutics, 
particularly  in  the  description  of  the  author's  new  method  for  the 
treatment  of  cancer. 

Mercuric  Cataphoresis.  —  The  cataphoric  administration  of 
mercury,  which,  so  far  as  the  author  is  aware,  is  original  with  him, 
is  accomplished  by  amalgamating  gold  electrodes  with  this  metal 
(i.e.,  causing  the  mercury  to  adhere  to  the  electrode  surface  by  first 
dipping  the  latter  into  weak  acid  and  then  into  mercury).  Employed 
as  a  positive  pole,  the  mercury  disappears,  together  with  probably  a 
minute  quantity  of  gold,  being  united  to  the  atoms  of  oxygen  and 
chlorine  produced  at  this  pole  by  the  electrolytic  decomposition  of 
the  tissues  to  form  oxychlorides,  which  are  diffused  by  the  cataphoric 
process  into  the  immediate  neighborhood  of  the  -electrode  along  the 


TRANSMISSION  OF  GALVANIC  CURRENTS.  45 

lines  of  cuiTent-llow.  Before  each  subsequent  application  the 
mercury  should  be  renewed,  though  a  second  freshening  with  acid 
may  not  be  necessary. 

The  immense  value  of  a  process  that  enables  us  to  diffuse 
mercury  in  atomic  proportions  directly  into  a  diseased  tissue  is  evident 
when  we  recall  the  well-known  qualities  of  the  metal  when  adminis- 
tered by  the  mouth,  and  realize  that  we  have  the  additional  advantage 
in  this  process  of  dealing  with  nascent  salts  of  the  metal, — a  condi- 
tion of  chemic  compounds  in  which  their  strongest  qualities  are 
evinced. 

It  is  my  belief,  supported  by  facts  detailed  elsewhere,  that  this 
method  will  be  of  immense  value  in  adding  to  the  sorbefacient  and 
alterative  actions  of  electricity  in  chronic  inflammatory  conditions 
and  their  sequels,  and,  more  important  still,  that  in  the  massive 
infiltration  of  neoplasms,  even  of  cancerous  character,  by  the  oxy- 
chlorides  of  lethal  metals,  we  have  the  best  method  of  destroying  the 
essential  principle  on  which  their  malignancy  depends  (see  page  236). 

An  incidental  advantage  in  employing  mercuric  cataphoresis 
instead  of  simple  positive  galvano-chemic  cauterization  in  many  intra- 
uterine applications  is  that  the  effect  is  less  caustic,  while  probably  of 
greater  benefit,  for  the  nascent  oxygen  and  chlorine  expend  their 
energy  on  the  mercury  instead  of  on  the  surrounding  flesh. 

General  Medicamental  Cataphoresis. — The  possibilities  of  the 
cataphoric  method  of  administering  remedial  agents  are  very  great 
and  but  slightly  realized  at  present  by  the  profession.  Its  chief  value, 
of  course,  is  when  we  either  wdsh  to  administer  the  remedy  to  a  certain 
locality  accessible  to,  or  in  the  near  neighborhood  of,  an  electrode, 
without  diffusing  it  throughout  the  system,  or  when  we  wish  to  over- 
whelm a  certain  locality  with  the  remedy  in  its  nascent  condition. 

All  active  principles  of  medicines  are  capable  of  being  so  adminis- 
tered, the  amount  transmitted  into  the  body  being  directly  governed 
by  the  millicoulombs  of  current  (see  page  283),  but  it  is  important 
to  carefully  select  the  pole  on  which  to  place  the  remedy  in  accordance 
with  its  chemic  nature.  This  is  readily  determined  of  those  sub- 
stances whose  constitution  we  know,  remembering  that  there  is  a 
double  action  going  on:  (1)  a  simple  electric  osmosis,  always  from  the 
positive  pole,  by  Avhich  salts  and  the  Avater  in  which  they  are  dissolved 
are  transmitted  inward  toward  the  negative  pole;  and  (2)  an  electro- 
lytic double  current,  in  which  the  molecules  of  the  compounds  are 


46  DISEASES    OF    WOMEN. 

broken  up  into  their  constituent  atoms,  the  oxygen  and  acids  going 
from  the  negative  to  the  positive,  and  hydrogen,  alkaUes,  and  the 
bases  going  from  the  positive  to  the  negative.  This,  of  course, 
means  that  such  substances  as  hydrochlorate  of  cocaine  and  the  salts 
of  other  alkaloids  should  be  placed  on  the  positive  pole,  the  active 
base  being  driven  inward  toward  the  negative  pole  and  the  useless 
hydrochloric  acid  adhering  to  the  positive  electrode.  Conversely, 
if  we  wish  to  administer  the  arsenic  in  arsenite  of  potassium  we  recall 
that  the  arsenious  acid  is  the  active  agent,  and  that  it  is  repelled  from 
the  negative  pole  to  the  positive;  the  solution  should  therefore  be 
placed  on  the  negative  pole. 

As  before  said,  certain  amounts  of  diffusion  of  the  salts  occur 
as  molecules  of  compounds  in  solution  by  simple  electric  osmosis,  this 
being  always  from  the  positive  pole. 

Kohlrausch  discovered  that  each  atom  has  its  own  rate  of  motion 
in  a  given  liquid,  independently  of  what  it  may  happen  to  have  been 
combined  with,  hydrogen  traveling  faster  than  any  other  atom. 
Lodge^  gives  the  subjoined  table  of  the  speed  of  atoms  of  the  sub- 
stances mentioned  when  urged  by  a  potential  of  1  volt  per  lineal 
centimetre  of  electrolyte.  The  rate  of  some  substances  of  interest 
in  this  connection  are  unfortunately  not  included. 

Table  of  Cataphoric  Speed  of  Atoms  at  One  Volt 
PER  Centimetre. 

Hydrogen 1.080  centimetres  per  hour. 

Potassium 0.205  centimetre  per  hour. 

Sodium   0.926 

Lithium   0.094 

Silver   0.166 

Carbon   0.213 

Iodine    0.216 

Functional  Stimulation  and  Sedation. — (a)  Indirect  Stimulation 
and  Sedation  Through  the  Medium  of  Nerve-trunhs. — In  addition  to 
electrolysis  and  cataphoresis,  which  are  effects  practically  obtainable 
only  from  galvanic  or  continuous  currents  of  appreciable  milliam- 
perage,  there  remains  to  be  considered  another  mode  by  which  elec- 


^  "Modern  Views  of  Electricity,"  Lodge,  p.  87. 


TRANSMISSION    OF    GALVANIC    CUERENTS.  47 

tricity  may  act  upon  the  body,  which  may  be  called  "functional  stim- 
ulation/' or  "sedation." 

In  its  indirect  form,  or  the  stimulation  of  organs  through  their 
afferent  nerve-trunks,  this  mode  of  action  has  been  the  one  most  gen- 
erally recognized  in  electro-therapeutics,  many  neurologists  practi- 
cally regarding  it  as  the  only  action,  though  in  real  importance  it  is 
often  overshadowed  by  electrolysis  and  cataphoresis.  Closely  con- 
nected with  current-  volume  and  concentration,  and  hence,  peculiarly 
displayed  by  galvanic  currents,  it  is,  by  virtue  of  its  appearance  at 
the  instant  of  variation  in  slight  currents  of  higher  voltage,  the  only 
appreciable  mode  of  action  of  faradic  and  franklinic  currents. 

When  the  special  functions  are  indirectly  stimulated  through  the 
nerves,  both  motor  and  sensory,  the  response,  even  in  the  galvanic,  is 
limited  mainly  to  the  moment  at  which  the  variation  occurs  in  the 
electric  condition  of  the  nerve.  The  functional  stimulation  thus  pro- 
duced occurs  at  increase  or  decrease  of  current  at  either  pole,  the 
response  being  proportional  to  the  amount  of  variation  and  to  its 
suddenness;  in  other  words,  an  increased  speed  of  variation  will  com- 
pensate for  less  current,  and  vice  versa.  For  speed  of  variation  we 
may  substitute  height  of  pressure  (which  has  been  defined  by  some  as 
synonymous  with  velocity),  for  it  is  also  true  that  the  greater  the 
pressure,  the  less  the  milliamperage  required  to  stimulate.  An  illus- 
tration of  this  may  be  found  in  the  fact  that  the  static  induced  cur- 
rent with  several  thousands  of  volts  pressure  and  less  than  the  mil- 
lionth part  of  a  milliampere  of  volume  will  contract  a  surface-muscle 
better  than  an  insufficient  dose  of  a  galvanic  current,  even  though  it 
be  several  milliamperes.  Though  with  weak  currents  nerve-stimula- 
tion is  thus  limited  to  the  moment  of  varying,  closing,  or  opening  of 
the  circuit,  with  strong  currents  the  stimulation  or  sedation  continues 
throughout  the  duration  of  the  application,  producing  a  continuous 
contraction  or  sensation.  All  current-variations  are  stimulant,  though 
the  continuous  galvanic  current  is  sedative  at  the  positive  pole,  and 
very  rapidly  successive  faradic  currents  of  high  voltage  and  minute 
amperage  will  act  as  an  analgesic. 

This  excitation  of  function  is  supposed  to  be  due  to  the  sudden 
polarization  or  depolarization  of  the  nervous  molecules  traversed  by 
the  current.  It  is  always  greatest  when  the  nerve  is  under  a  con- 
centrating electrode,  and  the  action  at  each  pole  of  the  galvanic  cur- 
rent differs  in  relative  visfor,  due  to  the  fact  that  a  condition  of  stimu- 


48  DISEASES    OF    WOMEN. 

lation  occurs  at  the  negative  pole,  or  cathode,  called  "catelectrotonus," 
and  one  of  sedation  at  the  positive  pole,  or  anode,  called  "anelectrot- 
onns."  These  differences  are  of  great  value  in  pelvic  applications 
and  also  give  rise  to  the  formulas  of  motor  response  so  important  m 
neurologic  diagnosis. 

Catelectrotonus. — If  a  nerve  be  subjected  for  a  few  moments  to 
the  action  of  the  negative  pole  of  a  galvanic  current  placed  in  its 
immediate  neighborhood,  it  has  been  demonstrated  that  its  excita- 
bility to  all  stimuli  is  distinctly  increased.  This  has  not  been  ade- 
quately explained,  but  it  is  possible  that  the  influx  of  fluids  into  the 
nerve  due  to  cataphoric  action  is  the  chief  cause. 

Anelectrotonus. — A  nerve  similarly  placed  with  respect  to  the 
positive  pole  has  its  irritability  decreased.  The  desiccating  effect  of 
this  pole  would  seem  to  explain  this  also.^ 

(h)  Direct  Organic  Stimulation  and  Sedation. — The  stimulating 
and  sedative  effects  of  the  galvanic  current  are  by  no  means  confined 
to  the  intermediate  agency  of  the  nerves.  Muscular  tissue  of  both 
the  voluntary  and  involuntary  kind  itself  responds  to  milliampere  cur- 
rents, and,  though  the  demonstration  of  direct  cellular  stimulation  is 
not  so  easy  in  other  organs  of  the  body,  it  is  extremely  probable  that 
glandular  and  secretory  organs  and  the  general  tissues  of  the  body 
liave  a  response  to  the  continuous  current  independently  of  their 
innervating  and  trophic  nerves,  similar  in  kind  to  the  skin  responses 
(blanching  and  reddening)  that  are  so  readily  observed  by  the  eye. 
It  is,  particularly,  this  general  tissue-stimulation  that  renders  galvanic 
applications  of  greater  value  in  gynecology  than  if  they  depended  on 
muscular  and  nerve  effects  only,  for  we  thus  influence  the  multiform 
processes  of  tissue-metabolism,  lymphatic  activity,  and  nutritive  re- 
pair, that  are  so  important  in  correcting  the  conditions  that  are  found 
in  the  pelvis  after  many  acute  or  chronic  inflammatory  processes. 

Bactericidal  Action  of  Electricity. — The  influence  of  the  constant 
current  on  the  vitality  of  microbes  has  been  investigated  by  Schiel, 
Cohn,  and  Mendelssohn,  and  most  recently  and  thoroughly  by  Apos- 


'  The  chief  factors  in  the  normal  formula  of  motor  responses  is  that  the 
first  response  appears  at  the  production  of  catelectrotonus,  or  cathodic  closure 
(closure  of  circuit  with  negative  pole  over  nen'e),  and  the  next  at  the  return 
of  a  relatively  cathodic  condition  (equal  to  disappearance  of  anelectrotonus)  at 
anodic  opening;  hence  the  formula:  K.  CI.  C."",  A.  0.  C",  A.  CI.  C",  K. 
O.  C 


TRANSMISSION    OF    GALVANIC    CURRENTS. 


49 


toll  and  Laguerriere.^  The  latter  observers  made  a  most  thorough 
study  of  the  subject  during  a  series  of  fifty-two  experiments  on  the 
microbes  of  anthrax,  pus,  and  various  non-pathogenic  varieties,  in 
which  140  guinea-pigs,  42  rabbits,  and  2  dogs  were  killed. 

The  apparatus  found  best  adapted  to  the  determination  of  the 
action  of  each  pole  is  shown  in  Fig.  20,  by  the  use  of  which  it  was 
possible  not  only  to  isolate  the  action  of  each  pole  in  its  tube,  but 
also  to  test  the  interpolar  effect  adjacent  to  each  pole.  As  was  to  be 
expected,  the  passage  of  strong  currents  from  the  surface  of  small 
platinum  spirals  through  the  peptonized  broth  used  caused  a  decided 
rise  of  temperature,  particularly  at  the  positive  pole.  In  some  of  the 
experiments  this  thermal  influence   was  eliminated  by  placing  the 


Fig.  20. — Apparatus  employed  by  Apostoli  for  testing  the 
bactericidal  action  of  electricity. 


apparatus  on  ice.  In  others  the  chemicals  liberated  at  each  pole  were 
eliminated,  either  by  the  use  of  an  absorbent,  such  as  magnesium  or 
lead,  at  the  positive  pole,  or  by  being  covered  with  a  vegetable  mucil- 
aginous material  called  gelosin.  The  results  showed  a  distinct  atten- 
uation or  destruction  of  the  microbes  when  currents  of  more  than  50 
milliamperes  were  used  for  five  minutes.  Beneath  that  dosage  the 
■action  of  the  positive  pole  actually  increased  the  virulence  of  the 
microbes,  doubtless  by  reason  of  the  addition  of  free  oxygen  to  the 
media  and  a  moderate  increase  of  temperature.    It  was  further  proven 


'  "De    rinfluence    du    Courant    Continii    sur    les    Microbes." 
Apostoli  et  Laguerriere.     Eeprint,  Paris.  1891. 


Par    MM. 


50  DISEASES    OF    WOMEN. 

that  neither  the  negative  pole  nor  the  transmitted  current  through  the 
interpolar  region  exerted  any  influence  on  the  vigor  of  cultures,  and 
that  the  action  of  the  positive  pole  was  entirely  dependent  on  the 
nascent  chemic  products  and  the  heat  that  were  developed. 

These  carefully-conducted  experiments  must  certainly  discourage 
the  use  of  galvanic  applications  as  germicides,  per  se,  within  the  body- 
cavities/  since  current-strengths  entirely  sufficient  to  cure  certain 
post-infective  cases  do  not  develop  that  quality;  but  in  this  disappoint- 
ment we  only  follow  the  experience  of  antiseptic  therapeutics  as  a 
whole  in  these  cases.  They  prove,  nevertheless,  that,  where  currents 
exceeding  50  milliamperes,  concentrated,  are  called  for  in  their  cura- 
tive capacity,  we  may  also  anticipate  a  direct  microbicidal  action  ac- 
companying them.  It  need  not  be  said  that  this  is  a  great  comfort 
in  electro-surgery  and  that  in  the  amperages  used  in  cancer,  for  in- 
stance (400  to  1000  milliamperes),  we  also  employ  a  most  efficient  and 
thorough  antiseptic  application.  For  antiseptic  action  in  currents 
under  50  milliamperes  we  must  rely  upon  antiseptic  eataphoresis,  in 
which  it  is  possible  that  minute  currents  may  be  made  efficient  by  sur- 
rounding the  active  pole  with  a  cotton  covering  holding  antiseptic 
solutions,  or  by  using  an  amalgamated  anode. 

The  Alterative  Action  of  Electricity. — Whatever  conclusions  are 
arrived  at  relative  to  the  bactericidal  action  of  electricity,  it  should 
not  be  forgotten  that  the  cure  of  the  latter  stages  of  affections  of  bac- 
terial origin  necessitatco  an  alteration  of  abnormal  nutritive  processes 
which  have  resulted  from  the  bacterio-phagocytic  contest.  Nature 
must  be  stimulated  and  assisted  in  the  removal  of  this  proliferated 
material;  hence  the  administration  of  electricity  for  quickening  cellu- 
lar metabolism  should  be  arranged  for  in  such  cases.  The  negative 
pole  of  the  galvanic  current  is  indicated  for  this  purpose. 

Indications  for  Choice  of  Poles. — The  determination  of  which 
galvanic  pole  to  use  in  gynecic  practice  will  be  specially  considered 
in  connection  with  each  affection,  but  it  is  rare  that  the  result  of 
experience  contravenes  certain  guiding-principles  derived  from  the 
facts  contained  in  the  foregoing  paragraphs.  From  them  it  is  apparent 
that  the  reasons  governing  choice  are  chemic,  cataphoric,  and  elec- 


*  Except  in  connection  with  mercuric  or  other  antiseptic  eataphoresis, 
which  acts  freely  and  immediately,  one  application  sufficing  to  asepticize  the 
worst  ulcer. 


TRANSMISSION    OF    GALVANIC    CURRENTS.  51 

trotonic.  The  positive  pole  is  therefore  microbicidal,  capable  of  diffus- 
ing medicaments,  drying,  depleting,  hemostatic,  and  sedative.  The 
negative  pole  is  congesting  and  therefore  a  qiiickener  of  absorption, 
increases  moisture  and  drainage,  dilates  canals,  produces  most  de- 
struction in  electrolytic  concentration,  and  is  most  stimulant. 

Interrupted  Galvanic  Currents  in  Gynecology. — Galvanic  inter- 
ruptions, either  rapidly  or  slowly  produced,  are  rarely,  if  ever,  used  in 
direct  pelvic  applications,  for  the  reason  that  they  are  far  more  pro- 
ductive of  pain  and  shock  than  faradic  currents  and  are  in  no  wise 
more  effective  than  the  latter.^  The  avoidance  of  sudden  current- 
variation,  indeed,  is  a  most  important  detail  in  the  majority  of  appli- 
cations of  this  sort,  and  it  is  for  this  reason  that  the  author  has 
insisted  on  the  gradually  increasing  and  decreasing  method  in  this 
work. 

Differences  Between  the  Currents  Used  in  Medicine. — What  has 
been  considered  in  the  preceding  pages  as  the  galvanic  current  is  the 
medical  designation  of  the  simple,  direct  current  of  electric  energy, 
which  would  require  no  special  designation  were  it  not  that  we  use 
other  forms  of  electric  currents  in  medicine  that  differ  greatly  in 
qualities  and  effects.  The  galvanic,  faradic,  sinusoidal,  and  franklinic 
currents  are  widely  different  remedies  in  practice,  though  they  are 
all  electric  currents  and  convertible  into  each  other  by  varying  the 
mode  of  construction  or  operation  of  the  generators  that  produce 
them;  that  is,  it  is  possible  to  do  so,  though  usually  inconvenient.  The 
EJison  current-dynamo  is,  however,  practically  a  faradic  machine  so 
constructed  as  to  give  a  galvanic  current. 

The  real  differences  in  these  currents  depend  on  the  proportions 
of  pressure  and  volume  they  possess,  and  whether  they  are  direct  or 
alternating,  continuously  flowing  or  a  discontinuous  series  of  induc- 
tions. Galvanic  currents  have  a  pressure  varying  from  a  few  volts 
when  a  few  cells  are  used  to  100  or  110  volts  or  more,  and  a  volume 
varying  from  1  to  500  milliamperes  or  more,  and  are  direct  and  con- 
tinuous unless  specially  interrupted.  Faradic  and  sinusoidal  currents 
are  said  to  have  a  pressure  of  about  100  to  300  volts,  according  to  the 
coil  and  core  used,  and  a  volume  of  a  small  fraction  of  a  milliampere 
(probably  from  Vio  to  ^Aooo  of  a  milliampere).     They  are  discon- 


^  This  statement  by  no  means  applies  to  the  neurologic  applications  of 
electric  currents. 


52  DISEASES    OF    WOMEN. 

tinuous  and  usually  alternating,  and  each  current-throb  is  of  ex- 
tremely short  duration.  Franklinic,  or  static,  currents  have  a  press- 
ure of  60,000  volts  or  more,  but  the  volume  is  probably  below  the 
millionth  part  of  a  milliampere. 


PLATE    I. — Arrangement  of   Examining   Chair  and    Apparatus. 


PLATE    II. — Arrangement   ot   Applying    Couch    and    Apparatus. 


CHAPTER    V. 

Typical  Methods  of  Applying  Electric   Currents 
IN  THE  Diseases  of  Women. 

Whatever  form  of  apparatus  is  selected  for  the  application  of 
electricity  in  both  the  medical  and  surgical  diseases  of  women,  it 
should  invariably  include  a  controller  through  which  both  the  faradic 
and  galvanic  currents  must  pass  before  reaching  the  patient,  since 
none  of  these  applications  necessitate  the  use  of  shocks  of  any  kind, 
and  sudden  accidental  variations  of  the  current  should  be  rendered 
impossible.  It  must  also  invariably  include  a  reliable  meter  through 
which  the  galvanic  current  must  always  pass  while  traversing  the 
patient. 

It  is  well  to  fix  upon  some  definite  relative  arrangement  of  the 
operating-chair  or  couch  and  the  apparatus.  The  author,  having 
educated  the  left  index  finger  for  the  gynecic  touch  in  the  early  years 
of  his  practice,  at  the  suggestion  of  the  late  Dr.  Goodell,  employs  this 
hand  particularly  for  the  examinations  and  the  manipulation  of  elec- 
trodes, leaving  the  right  hand  for  the  management  of  the  controller, 
switches,  etc.  The  relative  arrangement  of  the  chair  or  couch  when 
the  work  of  each  hand  is  similarly  determined  is  shown  in  Plates  I 
and  II. 

The  chair  or  table  should  be  used  in  making  diagnostic  exami- 
nations and  in  all  intra-uterine  applications.  The  couch  is  essential 
in  general,  spinal,  and  most  other  applications,  and  may  be  used  for 
vaginal  applications,  at  times,  by  the  acquirement  of  special  skill. 

The  typical  methods  of  applying  electricity  in  both  general  and 
local  affections  of  women  may  be  described  as  follows,  Vith  the  pre- 
liminary statement  that  the  active  electrode  (the  one  placed  nearest 
the  diseased  point)  is  invariably  placed  in  position  before  the  current 
is  turned  on,  the  controller-handle  being  carefully  placed  at  zero,  or 
the  starting-point,  and  that  the  current  is  turned  off  before  this  elec- 
trode is  removed,  avoiding  shocks  of  every  kind. 

General    Galvanic    Stimulation. — In    the    application    of    this 

(53) 


54  DISEASES    OF    WOMEN. 

method  the  patient  disrobes  and  lies  on  a  couch  on  which  a  sheet  or 
blanket  has  been  so  placed  that  both  ends  can  be  folded  over  the 
person.  On  this  and  beneath  the  back  a  large  dispersing  electrode 
is  placed  (page  309),  connected  with  the  positive  pole  of  a  galvanic 
current.  To  the  negative  cord  is  attached  a  round  active  pad,  moist 
and  well  soaped,  preferably  with  Ivory  soap.  Beginning  with  the  arm 
(Plate  III),  the  pad  is  held  in  contact  with  it  and  the  current  turned 
on  at  the  controller,  after  which  the  pad  is  passed  to  and  fro  over  the 
nerve-points  of  each  group  of  muscles,  taking  care  to  act  only  on 
groups  associated  in  action  at  one  time.  For  instance,  all  the  extensors 
of  the  hand  can  be  easily  moved  by  stroking  the  anterior  aspect  of 
the  forearm,  and  the  flexors  by  stroking  the  posterior.  The  pad  is 
slipped  from  one  side  to  another  without  breaking  contact,  and  the 
whole  arm  can  thus  be  successively  thrown  into  action  without  turning 
the  current  off.  On  finishing  the  arm  at  the  shoulder  the  current  is 
turned  off,  the  pad  removed,  and  the  arm  dried. 

The  same  procedures  are  enacted  with  the  other  arm  and  each 
leg  (Plate  IV),  after  which  the  pad,  freshly  moistened  and  soaped,  is 
applied  to  the  abdomen,  and  circular  movements  made  in  the  direc- 
tion of  the  colon  (Plate  V).  It  is  almost  always  wise  to  apply  a  pri- 
mary faradic  current  in  this  exact  manner,  through  the  controller,  to 
the  abdominal  organs  either  before  or  after  the  galvanic  application 
to  the  same  parts  (Plate  VI). 

The  patient  may  then  turn  over,  with  the  indifferent  pad  under 
the  abdomen,  and  the  galvanic  current  is  applied  to  the  back  and 
flanks  with  slow  movements  (Plate  VII). 

The  current-strengths  employed  in  this  method  vary  with  the 
part  of  the  body  and  the  amount  of  adipose  tissue  covering  the  nerve- 
points,  fleshy  persons  requiring  more  current.  Usually  from  15  to 
20  milliamperes  will  do  for  the  arms,  30  to  35  for  the  legs  and  thighs, 
and  from  50  to  100  for  the  abdomen  and  back.  The  nerve-points  for 
motor  stimulation  of  value  in  these  applications  are  shown  in  Plates 
VIII  and  IX: 

This  application  is  probably  the  most  powerful  stimulus  to  be 
found  in  general  electric  applications.  In  weak  and  nervous  people 
it  is  apt  to  be  followed  by  a  short  period  of  vascular  depression  and 
cold  extremities  preceding  the  reaction,  but  as  strength  is  gained 
the  warm  reaction  is  more  immediately  realized.  Tlie  method  will 
usually  be  found  to  be  preferable  to  faradic  stimulation  in  the  class 


o 


o 


TYPICAL    METHODS    OF    AITLICATION.  55 

of  cases  usually  placed  on  the  rest  cure,  and  may  also  be  used  alone 
in  cases  of  neurasthenia  Avhich  are  not  suitable  for,  or  will  not  submit 
to,  isolation  and  rest,  the  strong  currents  transmitted  through  the 
abdominal  viscera  being  particularly  valuable  in  arousing  dormant 
abdominal  nervous  forces  so  commonly  deranged  in  these  cases. 

General  Faradic  Stimulation. — The  patient  being  placed  as  de- 
scribed in  previous  paragraphs,  the  coil  to  be  used  selected  and  put 
into  operation  and  the  large  pad  adjusted  to  the  back,  the  applica- 
tions are  made  to  the  limbs  and  abdomen  in  the  same  manner  as  with 
the  galvanic  current,  the  controller  being  used  to  regulate  the  current- 
strength  to  the  amount  required  to  contract  the  several  groups  of 
muscles.  As  with  the  galvanic  current,  it  is  not  wise  to  use  more  than 
needed  to  obtain  a  full  motor  response,  since  additional  current  will 
only  give  unnecessary  pain.  This  monopolar  method  is  quite  essen- 
tial to  a  proper  faradic  stimulation  of  the  abdomen,  but  in  the  case 
of  the  limbs  the  Duchenne,  or  bipolar,  method  is  somewhat  preferable 
at  times,  producing  a  more  local  contraction  of  each  group.  In  this 
bipolar  method  the  two  ordinary  disk  electrodes  may  be  held  in  the 
same  hand,  the  negative  applied  to  the  nerve-point  and  the  positive 
near  it  on  the  belly  of  the  muscle. 

Abdomino-Dorsal  Applications. — The  patient  lies  on  the  back 
as  in  the  preceding  applications,  with  a  large  pad  under  the  dorsal  or 
lumbar  regions,  the  clothing  being  removed  from  the  field  of  appli- 
cation and  protected  from  wetting  by  folded  towels.  Making  sure 
that  all  current  is  turned  off  at  the  controller,  the  active  electrode, 
the  medium-sized  round  cotton  pad,  well  moistened  and  soaped,  is  next 
placed  on  the  abdominal  surface.  The  current,  whether  galvanic, 
faradic,  sinusoidal,  or  combined,  is  then  turned  on  until  the  desired 
strength  is  obtained  and  the  pad  slid  around  in  the  direction  of  the 
colon. 

The  large  electrodes  and  the  perfect  contact  assured  by  the  soapy 
lather  enable  a  considerable  density  of  current  to  be  carried  into  the 
abdomen,  since  we  can  readily  use  from  60  to  100  milliamperes,  and 
it  is  not  only  an  effective  way  of  impressing  the  nerve  and  muscular 
structures  of  the  pelvis  and  abdomen,  but,  by  an  upward  extension  of 
the  field,  we  are  enabled  to  act  favorably  on  the  stomach,  liver,  and 
possibly  other  digestive  organs. 

Spinal  Applications. — The  transmission  of  continuous  currents 
through  the  spinal  cord,  so  useful  in  many  neuroses  in  which  symp- 


56  DISEASES    OF    WOMEN. 

toms  referred  to  the  spinal  region  exist,  is  also  of  signal  value  in  the 
amenorrhea  and  dysmenorrhea  of  young  girls,  requiring  no  concur- 
rent medication  if  anemia  does  not  co-exist.  The  patient  sits  sideways 
in  a  chair  with  the  clothing  loosened  at  the  back,  and  two  spinal  elec- 
trodes are  used  (about  two  and  a  half  by  five  inches),  the  positive 
being  placed  immovably  on  the  lumbar  region,  and  the  negative  held 
in  contact  with  the  cervical  and  various  parts  of  the  median  and 
dorsal  regions,  in  turn,  giving  a  stabile,  or  stationary,  current  in  each 
region  of  a  minute's  duration.  From  10  to  70  milliamperes  may 
be  used,  in  accordance  with  the  patient's  endurance.  The  faradic 
current  is  not  used  in  this  manner,  as  it  would  doubtless  fail  to  act 
on  the  cord  or  deep-seated  nerve-roots. 

A  more  effective  application  than  this  is  simply  the  reverse  of 
the  abdomino-dorsal  application,  the  patient  lying  face  downward 
with  a  large  pad  under  the  abdomen  (Plate  VII).  The  round  pad  is 
thoroughly  soaped  and  passed  up  and  down  the  back,  employing  20 
to  40  milliamperes  on  the  cervical  and  upper  dorsal  regions  and  40 
to  60  on  the  lower  dorsal  and  lumbar  regions;  these  figures  may  all 
be  gieatly  exceeded  in  proper  cases. 

Vaginal  Galvanic  Applications. — All  the  galvanic  applications 
usually  made  to  the  vagina  are  for  the  purpose  of  bringing  organs 
situated  beyond  it  or  the  general  pelvic  contents  under  an  inter- 
polar  influence  (page  37).  They  are  all  necessarily  monopolar  there- 
fore, one  electrode,  the  active  pole,  being  within  the  vagina  and  the 
inactive  pole,  in  the  shape  of  a  large  pad,  either  on  the  abdominal 
surface  or  beneath  the  back.  If  the  active  electrode  can  be  pressed 
behind  the  exudation  or  enlarged  organ,  as  is  usually  the  case,  the 
indifferent  pad  may  be  on  the  abdomen,  otherwise  it  should  be  on 
the  back,  these  dispositions  of  the  electrodes  being  best  designed  to 
include  the  seat  of  disease  within  the  tract  of  densest  current-lines 
between  the  electrodes  (see  "Current-diffusion,"  page  32). 

Contrary  to  the  conclusions  expressed  in  previous  editions  of 
this  work,  it  should  be  said  that  the  conducting-surfaces  of  all  vaginal 
galvanic  electrodes  should  be  properly  covered  to  protect  the  vaginal 
mucous  membrane  from  irritation,  particularly  if  the  positive  pole  is 
used,  and  irrespective  of  the  metal  of  which  the  electrode  is  made. 
This  rule  applies  more  generally  to  vaginal  applications  than  to 
uterine,  because  it  is  not  usually  the  case  that  the  vaginal  application 
is  designed  for  the  vagina  itself,  but  for  the  structures  beyond,  the 


TYPICAL    METHODS    OF    APPLICATION. 


57 


covering  permitting  more  current  to  be  used  without  cauterization 
(page  31).  The  relatively  large  size  of  a  bare  vaginal  electrode  lessens 
this  cauterization  itself,  as  was  stated  in  previous  editions,  but  does 
not  entirely  obviate  it. 

A  large  experience  in  this  form  of  application  has  convinced 
me  that  the  best  and  most  convenient  covering  for  this  electrode 
is  absorbent  cotton  wound  about  the  conducting-surface  until  a  ball 
of  proper  shape  and  size  is  obtained,  the  covered  electrode  being  then 
dipped  in  warm  water  until  thoroughly  soaked  and  then  lubricated 
with  a  non-irritant  soap.  The  cotton  is,  of  course,  detached  and 
thrown  away  after  each  application,  permitting  the  electrode  (Fig.  21) 
to  be  thoroughly  cleansed  and  asepticized.  Dr.  Goelet  has  introduced 
a  clay-ball  electrode   designed  to   secure .  a   contact-surface   of  clay 


.BO 


Fig.  2L — Author's  cotton-covered  vaginal  electrode.    The  upper  instrument 

is  made  of  carbon.     The  lower  one  is  a  Leclanche  zinc,  covered 

M'ith  a  piece  of  rubber  tubing. 


within  the  vagina,  but  the  author  can  see  no  advantage  in  the  use  of 
this  substance  to  compensate  for  its  inconvenience  as  compared  with 
thoroughly  moistened  and  soaped  absorbent  cotton. 

The  soaped  electrode  may  be  easily  inserted  without  the  use  of 
a  speculum,  the  patient  being  usually  in  the  dorsal  gynecic  position. 
If  the  seat  of  mischief  is  mainly  in  the  posterior  cul-de-sac,  it  is 
inserted  there,  tilted  forward  somewhat,  away  from  the  rectal  nerves; 
if  in  the  right  or  left  ovarian  region,  it  is  placed  in  the  right  or  left 
fornix.  The  indifferent  pad  may  be  the  round  pad  described  on  page 
309,  the  large  cotton  pad,  or  the  Apostoli  clay  pad. 

The  active  electrode  is  not  inserted  until  the  battery  is  found 
to  be  in  readiness,  the  indifferent'  pad  adjusted,  and  a  glance  at  the 


58  DISEASES    OF    WOMEN. 

connections  and  controller  shows  the  latter  to  be  resting  at  the  start- 
ing-point. 

The  duration  of  a  vaginal  galvanic  application  may  vary  from 
five  to  ten  minntes,  rarely  longer  with  strong  currents  if  the  applica- 
tion be  daily.  It  should  be  repeated  at  least  thrice  weekly.  The  cur- 
rent-strength used  by  the  author  varies  from  40  to  150  milliamperes, 
usually  about  50. 

The  choice  of  pole  is  not  a  matter  of  indifference,  proving  that 
the  application  is  not  altogether  interpolar,  as  clinical  experience 
shows  a  distinct  advantage  in  the  use  of  the  positive  pole  in  conditions 
of  pelvic  inflammation  or  exudation  approaching  acuteness,  while 
the  negative  pole  causes  greater  congestion  and  quickening  of  the 
absorptive  processes. 

Vaginal  Faradic  Applications. — (a)  Monopolar. — The  technique 
of  monopolar  faradic  applications  to  the  vagina  is  exactly  similar  to 
the  galvanic  application  just  described,  except  that  the  electrode  sur- 
face may  be  smaller  and  may  be  either  covered  or  bare  as  most  con- 
venient, the  natural  moisture  of  the  vagina  being  sufficient  for  the 
conducting-joint  between  the  electrode  and  the  mucous  membrane. 
Much  has  been  written  concerning  the  advantages  of  certain  positions 
of  the  internal  electrode,  a  subject  that  will  be  discussed  in  connec- 
tion with  the  treatment  of  displacements.  If  the  purpose  of  the 
application  is  the  cure  of  relaxation  of  the  muscular  structures,  in- 
cluding the  uterus,  the  primary  current  turned  on  through  the  con- 
troller should  be  used,  of  a  strength  short  of  the  production  of  pain. 
If,  on  the  contrary,  the  purpose  be  to  overcome  pain,  whether  due  to 
congestion  or  to  neuralgic  conditions,  the  secondary  is  best. 

(&)  Bipolar. — Under  the  lead  of  Tripier  and  Apostoli  much  atten- 
tion has  been  directed  to  the  employment  of  bipolar  faradic  applica- 
tions to  both  the  vagina  and  uterus,  Tripier  having  been  chiefly  inter- 
ested in  developing  the  value  of  the  current  of  quantity  and  Apostoli 
that  of  a  high  electromotive  force  (page  324).  There  are  no  clear 
relative  indications  governing  a  choice  between  the  monopolar  and 
bipolar  applications,  some  physicians  resorting  almost  exclusively  to 
one  method  and  some  to  the  other;  but  it  is  clear  to  the  author  that 
the  bipolar  method  is  always  most  effective  in  the  control  of  pain. 
For  this  purpose  the  longest  and  finest  wire  is  usually  preferable, 
even  if  the  patient  asserts  that  she  feels  nothing.  I  say  usually  pref- 
erable, for  the  control  of  pelvic  pain  by  the  use  of  high-pressure  cur- 


TYl'ICAL    METHODS    OF    API'LICATION.  59 

rents  is  yet  an  empirical  study,  all)eit  in  the  main  successful,  for  we 
must  meet  the  varying  conditions  therapeutically  on  which  pain 
depends.  It  has  appeared  to  the  writer  that  when  the  pain  is  due  to 
relaxation  of  the  muscular  parts  that  a  bipolar  application  of  a  moder- 
ately contractile  cxirrent,  such  as  that  from  the  medium  Goelet  coil, 
is  best,  and  this  is,  perhaps,  due  to  the  current  setting  in  motion 
waves  of  contraction  in  unstriated  muscular  fibres,  resulting  in  added 
tone.  When  the  pain  is  more  truly  neuralgic  in  character,  on  the 
other  hand,  the  mere  analgesic  effects  of  the  longest  coils  of  No.  36 
wire  is  best. 

When  the  electrode  has  been  inserted  and  the  current  turned 
on  at  the  controller  the  electrode  should  be  held  immovably  in  place, 
as  any  movement  during  the  application  will  be  a  disturbance  of  the 
effect.  Dr.  Goelet's  modification  of  Apostoli's  instrument  (Fig.  22) 
has  distinct  advantages  in  the  ease  with  which  immobility  is  main- 
tained after  placement,  as  it  is  lighter  in  the  handle,  and  by  its  shape 


Fig.  22. — Goelet's  bipolar  vaginal  electrode. 

is  in  some  "cases  self-retaining.  The  whole  current  from  the  coil  used 
can  generally  be  employed,  and  the  duration  of  the  application  may  be 
from  four  to  ten  minutes  or  longer.  It  should  be  administered  daily 
if  practicable. 

Intra-uterine  Galvanic  Applications. — i^postoli,  to  whose  labors 
are  due  the  establishment  of  monopolar  intra-uterine  applications  of 
the  galvanic  current  as  a  scientific  procedure,  invariably  designates 
them  "galvano-cliemic  cauterizations.''  Such  they  always  are  if  the 
active  electrode  is  bare  and  the  current  suflficient  to  cauterize  when 
so  concentrated;  but  if  the  conducting-surface  of  the  intra-uterine 
electrode  is  covered  with  moist  cotton,  as  is  frequently  done  by  the 
author,  a  modified  cauterization  will  result,  unless  the  current  be  very 
strong  or  its  duration  prolonged.  A  distinction  should  therefore  be 
considered  to  exist  between  a  mere  galvanic  application  and  a  galvano- 
ehemic  cauterization. 

A  most  marked  difference  exists  in  the  nature  of  these  appli- 


60  DISEASES    OF    WOMEN. 

cations  in  accordance  with  the  pole  employed,  as  fully  described  at 
page  40.  If  simple  positive  cauterization  is  required,  it  is  essential 
that  the  exposed  surface  of  the  active  electrode  should  be  either  of 
platinum  or  carbon.  Should  any  decomposable  metal — such  as  copper, 
silver,  zinc,  or  iron — be  employed  at  the  positive  pole,  a  cataphoric 
application  results,  adding  important  additional  features  to  the  re- 
sults, which  may  be  advantageous  or  detrimental,  according  to  cir- 
cumstances (page  44).  When  the  active  electrode  is  negative,  it  does 
not  matter  of  what  the  electrode  is  composed. 

Instruments. — For  the  intra-uterine  electrode  Apostoli  and  some 
operators  in  this  country  use  a  sound  capable  of  being  covered  at  will 
by  a  sheath,  made  of  either  glass  or  hard  rubber,  or,  as  specially  com- 
mended by  the  former,  of  celluloid,  which  is  said  to  be  less  absorbent 
than  the  rubber  (Fig.  23).  These  sheaths  are  extended  backward  into 
handles,  through  the  whole  of  which  the  sound  slides,  and  to  which  it 


Fig.  23. — Apostoli's  intra-uterine  electrode.     The  electrode   (A)    slides 

in  the  handle   (Z>)    and  is  of  platinum.     At  C  is  shown  a 

movable  covering-tube  of  hard  rubber  or  glass. 


may  be  rigidly  connected  at  will  by  a  screw.  In  my  own  practice  I 
have  found  that  this  arrangement  presented  certain  disadvantages. 
It  is  difficult  to  render  the  interior  of  the  tube  aseptic,  and  the  best 
antiseptic — the  flame  of  an  alcohol-lamp — cannot  be  applied  to  the 
exterior  of  the  rubber  and  celluloid  sheaths,  owing  to  their  inflam- 
mable nature.  In  most  cases,  moreover,  the  insulating  cover  should  be 
extended  beyond  the  bend  of  the  sound,  in  order  that  the  cervix  may 
be  protected  from  unnecessary  cauterization  and  the  current-action 
confined  to  the  interior  of  the  corpus  alone.  This  is  impossible  if  the 
sheath  is  made  of  a  rigid  material,  and,  were  it  possible,  the  abrupt 
increase  of  ca-libre  at  the  end  of  the  cover  would  render  the  proper 
introduction  of  the  sound  impossible  in  many  cases. 

An  exceedingly  handy  Avay  to  insulate  a  sound  to  any  extent 
found  desirable  in  a  given  case,  after  the  proper  curve  has  been  given 
to  it,  and  at  the  same  time  to  thoroughly  sterilize  it,  is  to  heat  it  to 
a  considerable  temperature  in  the  flame  of  an  alcohol-lamp  or  Bunsen 


TYPICAL    METHODS    OF    APPLICATION.  61 

burner,  and  melt  upon  it  a  sullicient  coating  of  pure  gum-shellac. 
This  forms  a  smooth,  highly-insulating  covering  that  adheres  tightly 
to  the  soimd  and  shades  off  in  thickness  at  the  bare  end  so  gradually 
as  to  readily  admit  a  passage  wherever  desired.  The  fusibility  of  the 
shellac  without  burning  is  its  greatest  advantage  over  the  best  quality 
of  sealing-wax,  but  the  latter  may,  however,  be  substituted  for  it 
if  the  shellac  is  not  readily  obtained.  In  covering  the  hot  sound  at 
first  the  coating  retained  by  it  is  too  thin  for  safe  reliance,  and  it 
should  be  made  heavier  after  cooling  by  attaching  additional  quanti- 
ties of  melted  gum-shellac  to  it,  the  whole  being  then  reduced  to  a 
uniform  thickness  by  gentle  fusing. 

This  procedure  is  only  adapted  to. a  rigid-shanked  sound,  though 
the  curved  portion  may  be  flexible,  for  after  the  parts  are  once  covered 
there  should  be  no  danger  of  the  covered  portion  bending,  as  the 
material  breaks  easily,  giving  rise  to  leaks  when  in  use.     This  dis- 


Fig.  24. — Author's  sound-shaped  pkitinum  intra-uterine  electrode, 
with  fusible  covering  of  shellac. 


advantage  is,  however,  more  apparent  than  real,  for  nothing  is  more 
trying  in  this  work  than  an  attempt  to  employ  one  of  the  flexible- 
shanked  electrodes  made  by  some  manufacturers,  who  erroneously 
insist  upon  making  the  curved  portion  rigid  and  the  shank  flexible. 

Fig.  2-1:  represents  the  electrode  usually  employed  by  the  author, 
for  whom  it  was  made  by  Flemming.  It  bears  a  general  resemblance 
to  the  Simpson  sound,  with  a  hard-rubber  handle  of  the  usual  flat 
shape  for  indicating  its  position  in  uteri,  and  the  addition  of  a  socket 
for  the  attachment  of  the  conducting-cord.  The  two  and  a  half 
inches  which  may  be  left  bare  at  the  extremity  are  made  of  platinum, 
to  adapt  it  for  use  as  a  positive  pole.  The  covering  should  be  made 
to  reach  the  platinum  alwa3's,  and  it  is  generally  best  to  protect  the 
OS  and  cervix  by  carrying  it  to  a  point  which  will  protect  these  parts 
when  the  instrument  is  inserted. 

Before  each  application,  and  after  the  desired  curve  has  been 


62  DISEASES    OF    WOMEN. 

imparted  to  the  end,  this  electrode  should  be  sterilized  and  any  acci- 
dental breaks  closed  by  a  thorough  heating  of  the  bare  part  and  fusing 
of  the  first  two  or  three  inches  of  the  covering. 

But,  whenever  it  can  be  inserted,  the  best  intra-uterine  electrode 
for  all  non-cataphoric  applications  is  the  author's  spiral  platinum 
electrode  (Fig.  25),  which  conforms  itself  so  accurately  to  the  cavity 
as  to  be  capable  of  insertion  at  times  without  being  felt  by  the  patient. 
Its  painlessness  and  self-conformability  even  enable  us  to  successfully 
employ  intra-uterine  applications  at  times  when  the  uterus  is  fixed 
by  subacute  inflammations  of  the  peritoneum  or  adnexa.  Owing  to 
these  advantages,  the  author  always  selects  it  in  preference  to  the  stiff, 
covered  electrode,  unless  the  cavity  is  so  tortuous  or  contracted  as  to 
demand  the  rigid  instrument.  If  the  uterus  is  sufficiently  patulous  and 
it  is  desirable  to  modify  the  local  effect,  it  may  be  covered  by  twisting 
a  light  layer  of  absorbent  cotton  about  the  exposed  portion  as  an 
applicator  is  covered,  the  cotton  being  then  soaked  in  warm  water 


Fig.  25. — Author's  spiral  elastic  intra-uterine  electrode  of  platinum. 

and  soaped,  or  moistened  with  an  antiseptic  solution.  When  prop- 
erly applied  it  is  impossible  to  lose  the  cotton  within  the  uterus,  and, 
in  fact,  it  must  be  burnt  off  after  use,  as  the  spiral  will  be  injured  by 
much  traction  on  it;  the  burning,  however,  though  troublesome,  is 
always  necessary  for  cleansing  purposes.  The  shank  of  this  instru- 
ment is  best  insulated  with  shellac  or  sealing-wax,  an  described,  the 
material  being  carried  down  over  the  joint  between  the  platinum  and 
brass,  permitting  the  whole  instrument  to  be  more  thoroughly  asep- 
ticized than  would  be  possible  with  a  movable  or  other  cylindrical 
covering.  The  instrument  was  suggested  originally  on  the  lines  of 
electrodes  devised  by  Drs.  Franklin  Martin  and  A.  H.  Buckmaster, 
which  consist  of  platinum  wire  wound  about  bougies,  but  these  had 
the  disadvantage  of  being  capable  of  less  thorough  asepsis.  An  experi- 
ence of  nine  years  has  convinced  me  of  its  great  usefulness. 

In  endometritis,  accompanied  by  hemorrhages,  and  in  incipient 
cancer  of  the  cervix,  I  have  recently  employed  zinc-amalgam  cata- 
phoresis  with  one  of  the  electrodes  shown  in  Fig.  26  in  preference 


TYPICAL    METHODS    OF    APPLICATION. 


63 


to  either  platinum  or  carbon  electrodes.  They  are  also  best  insulated 
with  shellac  to  preserve  the  joint  between  the  shank  and  olive.  Before 
use  they  should  be  cleansed  by  heating  and  then  freely  amalgamated 
by  being  dipped  into  amalgamating  solution  or  battery  solution  and 
then  into  mercury.  The  result  is  a  bright,  smooth  surface  that  is 
practically  lubricated  by  the  mercury,  rendering  insertion  easy;  and 
as  the  mercury  coating  is  the  metal  acted  on  when  it  is  used  as  anode, 
the  electrode  will  not  adhere  to  the  surface  even  after  a  strong  current 
has  been  used. 

It  is,  as  a  rule,  far  easier  to  insert  all  intra-uterine  electrodes  by 
touch  without  a  speculum,  as  advised  by  Apostoli,  the  position  of  the 


Fig.  26. — Set  of  zinc  intra-uterine  electrodes  for  mercuric  cataphoresis. 


uterus  previously  ascertained  by  the  bimanual  touch  being  thus  more 
readily  followed  than  if  sight  is  depended  on  (see  Fig.  8). 

The  indifferent  electrode  may  be  either  the  large  or  small  pad 
described  on  page  309,  or,  if  the  current  is  to  be  strong,  a  freshly-made 
clay  pad. 

Position. — The  dorsal  position  on  a  gynecic  chair  or  table  is  the 
preferable  one  for  this  application,  though  the  patient  may  lie  across 
a  firm  bed  with  the  feet  on  chairs  or  on  the  operator's  knees,  or  may 
lie  lengthwise  in  bed  if  the  insertion  is  easy  and  the  local  conditions 
are  familiar  to  the  operator. 

Preliminarii  Details. — Apostoli  and  most  authors  advise  anti- 


64  DISEASES    OF    WOMEN. 

septic  flushing  of  the  vagina  immediately  before  each  application, 
but  the  author  has  long  since  given  up  this  tedious  and  often  un- 
pleasant procedure,  relying  altogether  on  a  fire-cleansed  instrument 
and  scrupulous  cleanliness  of  the  finger  in  addition  to  the  daily  douche 
enjoined  on  some  patients,  and  in  many  thousands  of  such  applica- 
tions has  never  encountered  sepsis.  The  natural  secretions  of  the 
vagina  are  in  some  cases  an  assistance  to  a  painless  insertion,  acting 
as  a  vaginal  lubricant. 

Before  inserting  the  instrument  the  proper  working  of  the  bat- 
tery, soundness  of  conducting-cords,  and  proper  position  of  the 
switches  should  be  ascertained,  and,  if  no  assistant  is  at  hand,  the 
indifferent  pad  should  be  first  placed  in  position. 

The  Current-  strength  and  duration. — As  the  conditions  in  which 
intra-uterine  galvano-chemic  cauterizations  are  advisable  vary  from  a 
slight,  but  persistent,  endometritis  of  an  otherwise  normal  uterus  to 
the  most  extreme  case  of  uterine  hypertrophy,  hemorrhage,  or  ab- 
normal growths,  so  the  efficient  dosage  varies  through  an  even  greater 
gamut  of  change,  additionally  influenced,  as  it  is,  by  the  individual 
idiosyncrasy  as  to  pain.  Where  tlie  hypertrophy  is  great,  and  espe- 
cially where  the  uterus  participates  in  the  growth  and  abnormities  of 
an  intramural  tumor,  the  strength  may  be  as  much  as  150  to  200 
milliamperes,  as  it  is  pretty  clearly  established  that  the  total  effect 
depends  more  on  the  number  of  milliamperes  in  circuit  than  upon 
the  duration  of  the  application.  It  is  true,  of  course,  that  the  actual 
amount  of  electrolysis  produced  by,  say,  200  milliamperes  in  five 
minutes  can  be  secured  by  50  milliamperes  in  twenty  minutes;  but 
the  effect  in  the  latter  case  would  differ  nevertheless,  for  it  would  be 
entirely  lacking  in  a  powerful  action  within  the  interpolar  region, 
which  is  depended  on  to  influence  the  contractile  tissue  not  directly 
affected  by  the  cauterization.  It  should  be  remembered  also  that 
mere  electrolysis  does  not  describe  the  action  obtained,  and  that  the 
caustic  effect  of  slowly-liberated  chemicals  does  not  compare  with  that 
of  a  liberation  en  masse.  Currents  exceeding  50  milliamperes  are, 
however,  to  be  reached  only  after  the  tentative  use  of  weaker  currents. 

On  the  other  hand,  slight  cases  of  subacute  or  chronic  endome- 
tritis, unaccompanied  by  hyperplasia,  may  be  effectively  treated  and 
quickly  cured  by  applications  of  20  or  30  milliamperes  for  five  minutes, 
and,  such  being  the  case,  it  is  manifestly  improper  to  subject  the 
patient  to  a  more  heroic  treatment.    In  cases  of  hysteric  or  neuralgic 


TYPICAL    METHODS    OF   APPLICATION.  65 

pain,  in  which  it  is  thought  wise  to  use  intra-uterine  galvanic  appli- 
cations, an  even  greater  circumspection  should  be  used,  for  cauteriza- 
tions should  be  gauged  primarily  to  the  amount  of  organic  disease 
present. 

It  is  a  safe  rule,  therefore,  to  gauge  the  dose  to  the  amount  of 
organic  change  within  the  uterus  or  in  tumors  closely  attached  to  it, 
subject  to  modification  at  any  moment  on  the  appearance  of  pain. 

As  to  the  duration  of  an  application  not  interrupted  by  the 
appearance  of  pain,  I  have  every  reason  to  commend  Apostoli's  rule 
of  five  minutes  as  an  average  application,  though  I  frequently  main- 
tain it  but  four  minutes.  Given  a  large  hypertrophy  or  tumor  and 
easy  tolerance  of  the  current,  it  is  better  to  extend  the  current  increase 
rather  than  its  duration,  as  there  is  less  risk  of  producing  breaks  in 
the  cuticle  of  the  abdomen  and  the  resultant  burns. 

Minor  Details  of  the  Application. — 1.  The  patient's  clothing 
should  be  sufficiently  removed  at  the  waist  to  render  it  easy  to  apply 
the  indifferent  pad  without  wetting  or  soiling  it. 

2.  If  there  are  any  abrasions  or  pimples  on  the  abdominal  sur- 
face, they  should  be  covered  with  pieces  of  paper  smeared  with  vaselin, 
or  in  some  similar  manner,  before  the  indifferent  pad  is  applied. 

3.  The  insulation  of  the  active  electrode  should  always  be  exam- 
ined for  imperfections  before  insertion. 

4.  Glance  at  the  controller  to  make  sure  that  no  current  is  on 
before  inserting  the  active  electrode. 

5.  Pain  may  be  relieved  by  only  a  slight  reduction  of  the  current. 

6.  Both  patient  and  instruments  should  remain  motionless  dur- 
ing the  application,  to  prevent  accidental  disarrangement  of  the 
apparatus. 

7.  The  patient  should  be  warned  that  she  may  have  colicky  pains 
within  six  hours  after  treatment,  followed  by  soreness  the  following 
day,  and  that  the  leueorrhea  may  be  temporarily  increased. 

After  the  Application. — It  is  usually  best  to  have  the  patient  rest 
awhile  before  going  home,  but  if  a  means  of  conveyance  is  handy  this 
will  not  be  necessary.  In  every  case,  however,  where  at  least  a  hun- 
dred milliamperes  have  been  used,  she  should  lie  dow^n  after  reaching 
home  and  remain  inactive  during  the  remainder  of  the  day.  It  is 
well  to  tell  her  plainly  that  a  neglect  of  this  precaution  may  cause 
serious  congestion,  entailing  much  discomfort. 

Contra-indications. — The     intra-uterine     electrode     should,     of 


66  DISEASES    OF    WOMEN. 

course,  not  be  inserted  either  as  a  sound  or  electrode  at  any  time 
during  pregnancy,  and  the  physician  is  wise  to  make  inquiry  as  to  the 
regularity  of  the  periods  in  every  case  before  inserting  it.  Certain 
patients  will  too  gladly  refrain  from  enlightening  him  if  they  can 
do  so. 

It  should  not  be  inserted  during  acute  inflammations  of  the 
uterus  or  the  adnexa,  though  an  elastic,  cotton-covered  instrument 
may  be  safely  employed  vrith  mild  currents  within  the  cavity  in  sub- 
acute salpingitis  after  a  course  of  vaginal  applications.  The  question 
of  employing  intra-uterine  applications  as  a  diagnostic  and  a  thera- 
peutic agent  in  these  conditions  will  be  found  discussed  elsewhere. 

Finally,  intra-uterine  applications  should  never  be  made  for  neu- 


Fig.  27. — Apostoli  bipolar  intra-uterine  electrode  with  fusible, 
aseptic  covering. 


ralgia  or  general  conditions  of  any  character,  being  reserved  strictly 
for  cases  involving  organic  changes  in  the  uterus  itself. 

Intra-uterine  Faradic  Applications. — It  is  quite  customary  in 
the  writers  practice  to  turn  on  either  a  primary  or  secondary  faradic 
current,  monopolar,  after  a  galvanic  application  to  the  uterine  cavity, 
for  its  contracting  or  sedative  effect,  though  it  is  rare  that  an  instru- 
ment is  inserted  into  the  uterus  for  the  faradic  current  alone  except 
in  early  cases  of  subinvolution.  Wlien  inserted  for  this  current  alone 
it  is  preferably  bipolar,  the  Apostoli  instrument  (Fig.  27)  having  been 
so  modified  by  Flemming,  at  my  request,  as  to  permit  it  to  be  asepti- 
cized in  the  flame.  This  is  done  by  substituting  fused  hard  rubber 
and  shellac  for  the  tubing  usually  on  these  instruments.  The  indica- 
tions and  choice  of  coils  are  discussed  elsewhere  (page  318). 


CPIAPTER  VI. 

Additional  Systematic  Methods  in  Gynecic  Practice. 

While  the  author  believes  that  in  the  rational  and  thorough 
application  of  electricity  the  physician  has  the  most  potent  means 
of  combating  a  large  proportion  of  the  chronic  organic  and  functional 
diseases  of  women  for  the  reasons  given  elsewhere,  he  by  no  means 
underestimates  the  remedial  value  of  a  number  of  other  methods  of 


Fig.  28. — Knee-chest  position.     (Drawn  from  photograph  of  model.) 


assisting  nature  in  re-establishing  a  normal  nutrition  and  normal 
performance  of  function.  Some  of  these  methods  may  be  here  de- 
scribed,  particularly  those  coming  under  the  general  description  of 
means  that  may  be  used  alone  or  in  conjunction  with  electricity  in 
curing  these  affections  without  resorting  to  surgery. 

Posture. — We  are  indebted  to  Dr.  H.  F.  Campbell,  of  Georgia^ 
for  a  systematic  method  of  replacement  of  prolapsed  and  retroverted 
uteri  in  which  the  normal  gravitation  of  the  vagina  is  reversed  by 
placing  the  patient  in  the  knee-chest  position  (Fig.  28)  and  admitting 

(67) 


68  DISEASES    OF    WOMEN. 

air  into  the  vaginal  orifice.  In  the  conditions  of  relaxation  of  the 
vaginal  and  abdominal  walls  present  in  these  affections  the  admission 
of  the  air  permits  the  parts  to  fall  forward  by  their  own  weight.  This 
is  the  only  proper  method  of  reposition  of  these  parts  by  the  physician 
prior  to  inserting  the  sound,  but  is  especially  advocated  by  Dr.  Camp- 
bell as  a  "jjneumatic  self-replacement"  method  by  which  the  patient 
herself  inserts  a  small  tube  while  in  the  posture  when  retiring  at  night 
and  on  rising  in  the  morning.  Any  short  tube  with  rounded  edges 
will  do  for  this  purpose,  preferably  a  small  glass  tube,  but  the  detached 
vaginal  nozzle  of  a  syringe  answers  every  purpose.  It  is  important 
to  remember  that  the  clothing  about  the  waist  should  be  well  loosened 
before  resorting  to  this  valuable  procedure,  and  that  the  thighs  should 
be  perpendicular,  as  shown  in  the  drawing,  with  the  sternum  directly 
in  contact  with  the  couch. ^ 

Hydrothermal  Applications  to  the  Pelvis. — The  Hot  Vaginal 
Douche. — Vaginal  injections  are  of  service  in  a  variety  of  ways,  either 
for  cleansing  purposes,  for  vaginitis,  and  as  a  method  for  modifying 
the  circulatory  and  nutritive  conditions  of  the  pelvic  organs.  It  is 
their  use  for  the  latter  purpose  that  requires  mention  in  this  place. 

Emmett  was  the  first  to  popularize  the  use  of  the  hot  douche  of 
sufficient  bulk  to  modify  pelvic  conditions  and  administered  in  the 
recumbent  position,  and  it  may  be  stated  that  it  is  only  in  this  posi- 
tion and  when  followed  by  repose  that  it  is  valuable  as  an  alterative. 
It  is  readily  administered  by  the  nurse  while  (he  patient  lies  in  bed 
by  the  use  of  a  bed-pan  and  a  pillow  laid  just  above  it,  a  board  being 
slipped  under  the  sheet  if  the  mattress  be  soft  and  yielding.  It  may 
also  be  administered  by  the  patient  herself  as  follows:  Procure  a 
square  yard  of  rubber  sheeting  and  lay  it  on  one  side  of  the  bed  with 
the  projecting  side  draped  to  convey  the  water  into  a  vessel  placed 
beneath  it  on  the  floor.  She  then  fills  a  two-quart  fountain-syringe 
with  plain  or  medicated  hot  water  of  a  temperature  barely  permit- 
ting the  hand  to  be  held  in  it,  and  hangs  it  on  the  head-board  of  the 
bed  at  a  height  of  about  two  feet  from  the  mattress.  She  then  lies 
across  the  bed  with  the  hips  on  the  rubber  sheet  and  the  vulva  close 
to  the  edge  of  the  bed,  each  foot  being  supported  on  a  chair  drawn 
alongside,  when  the  nozzle  may  be  inserted  and  the  catch  released. 


'  Dr.  Skene  limits  this  procedure  as  a  self-treatment  to  this  position  only, 
wisely  condemning  any  elaborate  eflForts  at  self-medication. 


ADDITIOXAL    SYSTEMATIC    METHODS.  69 

The  nozzle  should  be  constructed  with  side-openings  only  and 
should  be  of  large  size  at  the  tip  to  prevent  injection  of  the  water 
into  the  uterus, — an  accident  that  has  frequently  resulted  in  painful, 
and  even  dangerous,  uterine  contractions.  Improved  devices  are  now 
sold  for  vaginal  douching,  particularly  instruments  which  occlude  the 
vulvar  opening  and  compel  a  dilatation  of  the  rugse  of  the  vagina  and 
a  more  thorough  application  of  the  fluid. 

The  remedy  is  unquestionably  a  valuable  one  in  acute  and  sub- 
acute pelvic  inflammation,  and  particularly  in  pelvic  peritonitis,  but 
the  author  sees  many  cases  of  more  chronic  inflammation  in  which  it 
has  failed  to  be  of  use.  A  word  of  caution  should  be  said  concerning 
the  relaxing  and  what  might  be  called  tactile  benumbing  effects  of 
this  procedure  when  practiced  for  too  long  a  time.  Certain  cases  of 
abnormal  relaxation  and  insensitiveness  have  been  observed  by  me  in 
young  women  who  had  gone  through  a  course  of  treatment  of  this 
nature,  but  this  may  have  been  due  to  the  fact  that  they  had  been  led 
to  continue  the  practice  indefinitely  for  the  temporary  relief  afforded 
or  by  reason  of  a  belief  in  its  necessity  as  a  means  of  keeping  "clean." 
Now  it  is  quite  evident  that  nature  never  designed  that  these  sensitive 
parts  should  require  cleansing  in  this  way,  and  that  even  the  repeated 
contact  of  simple  w^ater  may  have  a  hardening  effect  on  virgin  sur- 
faces, at  least,  that  are  normally  bathed  in  mucus.  The  normal 
vagina  is  quite  capable  of  attending  to  its  own  cleansing  in  a  physio- 
logic way.  If  this  secretion  is  abnormal  the  douche  is,  of  course, 
imperative,  but  when  the  abnormal  secretion  is  of  uterine  or  tubal 
origin,  something  more  definite  in  the  treatment  of  the  seat  of  the 
discharge  is  needed  and  no  amount  of  vaginal  w^ashing  will  be  effective. 

Vag-inal  Swabbing-. — For  refractory  cases  of  colpitis  the  best 
application  is  a  douche  of  sublimate  solution,  1  to  5000,  administered 
by  the  physician  through  a  speculum,  or  the  vagina  may  be  swabbed 
out  with  pledgets  of  absorbent  cotton  dipped  in  the  same  solution  or 
in  equal  parts  of  tincture  of  iodine  and  glycerin. 

The  iodine  and  glycerin  swabbing  is  also  a  favorite  method  with 
some  in  the  treatment  of  chronic  pelvic  inflammation,  whether  affect- 
ing the  uterus  and  appendages  alone  or  the  cellular  tissue,  but  is 
usually  inferior  to  positive  vaginal  applications  of  the  galvanic  current 
with  a  cotton-covered  electrode. 

Tampons. — The  tampon,  constructed  of  a  cylindrical  wad  of 
absorbent  wool,  or,  in  its  absence,  of  absorbent  cotton,  has  of  late 


70  DISEASES    OF    WOMEN. 

become  a  favorite  routine  treatment  for  chronic  pelvic  inflammation 
and  for  conditions  of  the  uterus  formerly  treated  by  pessaries.  For 
this  purpose  the  tampon  is  medicated  with  various  substances,  chiefly 
boroglyceride  or  some  other  preparation  of  glycerin  for  Its  drainage 
effect.  In  constructing  the  tampon  for  this  purpose  a  piece  larger 
than  the  palm  of  the  hand  is  spread  out  in  the  form  of  a  cup  and  the 
boroglyceride  poured  in;  the  outer  portions  are  now  brought  together 
and  tied  with  a  string  long  enough  for  both  ends  to  project  beyond 
the  vulva.  It  is  now  inserted  quickly  through  the  speculum  already 
in  position  by  means  of  dressing  forceps,  enough  cotton  being  left 
dry  to  prevent  the  liquid  from  exuding.  This  is  left  in  from  eight  to 
twelve  hours,  at  the  end  of  which  time  it  is  withdrawn  by  the  patient 
by  traction  on  the  strings,  and  the  vagina  is  thoroughly  douched. 

In  the  use  of  the  tampon  for  checking  hemorrhage  the  Sims 
position  and  Sims's  speculum  are  decidedly  preferable,  the  vagina 
being  packed  full  of  iodoform  gauze  by  tucking  in  a  little  at  a  time 
and  packing  the  vault  first.  In  the  absence  of  the  gauze,  pledgets  of 
absorbent  cotton  dipped  in  a  saturated  solution  of  alum  and  pressed 
dry  may  be  used  instead.  The  tampon  should  be  removed  by  the 
physician  himself  at  the  end  of  twenty-four  or  thirty-six  hours, 
and  the  vagina  should  be  cleansed  and  repacked  if  necessary.  This 
procedure  is  invaluable  in  dangerous  hemorrhages,  but  is  rarely  neces- 
sary when  we  have  at  hand  the  primary,  or  the  coarse-wire,  faradic 
current,  by  means  of  which  the  source  of  the  bleeding  may  be  directly 
controlled  by  causing  immediate  contraction  of  the  uterus. 

Pessaries. — Of  pessaries  and  other  artificial  supports  of  the  uterus 
the  author  has  but  little  to  say  that  is  not  condemnatory,  since  they 
usually  produce  a  harmful  distension  of  the  vagina,  with  ultimate 
disappearance  of  the  muscular  coats.  He  has  been  able  to  obtain 
better  results  by  electricity  in  all  cases  except  those  of  pronounced 
paralysis  or  muscular  degeneration  of  the  vaginal  walls  (generally 
contributed  to  or  caused  by  a  long  course  of  pessary  wearing)  with 
cystocele  or  rectocele,  and  in  this  exceptional  class  alone  has  obtained 
good  results  from  the  Smith-Hodge  pessary  where  the  perineum  was 
at  least  partially  intact. 

Massage. — Massage,  or  the  art  of  applying  intermittent  mechan- 
ical force  to  the  tissues  of  the  body,  is  a  most  important  adjuvant  to 
electricity  in  the  treatment  of  the  neuroses  of  women  and  the  neural 
consequences  of  pelvic  and  abdominal  disease.    In  the  disorders  under 


ADDITIONAL    SYSTEMATIC    METHODS.  71 

consideration  it  becomes  of  value  mainly  as  a  peripheral  application 
and  as  a  means  of  restoring  general  nutrition.  As  such,  it  is  a  neces- 
sity in  the  "rest,"  or  Weir  Mitchell,  treatment,  and  may  be  useful  at 
times,  though  less  frequently,  in  the  treatment  of  ambulant  cases. 
For  descriptions  of  the  methods  of  applying  massage  and  of  its  physi- 
ologic action  in  the  cure  of  disease  the  reader  is  referred  to  the  works 
of  Schreiber,  Douglas  Graham,  Dowse,  and  others. 

The  author  regards  massage  with  the  hand  as  the  only  efficient 
method  of  using  the  agency  in  the  class  of  cases  under  consideration, 
rejecting  all  machinery,  muscle-beaters,  etc.,  as  either  but  poor  sub- 
stitutes for  the  hand  of  the  masseur  or  as  presenting  an  entirely 
different  therapeutic  measure. 

Most  books  on  massage  treat  more  fully  of  Swedish  movements 
than  of  massage  proper.  "Wliile  the  former  have  a  vers'  great  value  in 
many  chronic  conditions,  the  latter  is  particularly  indicated  in  the 
class  of  affections  under  consideration,  the  Swedish  movements  being 
added  in  the  shape  of  passive  movements  of  the  joints  only. 


CHAPTEE  YII. 
Menstrual  Derangements. 

Menstruation,  essentially  a  neuro-vasciilo-glandular  phenome- 
non, is  probably  more  directly  affected  by  electric  applications  than 
any  other  function  of  the  body.  Demanding  a  certain  equipoise  of  the 
nervous  elements  constituting  the  aptly-named  "abdominal  brain," 
the  inevitable  result  of  currents  so  applied  as  to  affect  these  nerve- 
structures  is  the  regulation  of  the  function  when  deranged  in  any 
way,  particularly  when  the  flow  is  aperiodic  or  deficient  in  quantity 
or  quality.  The  condition  present  in  many  cases  is  essentially  of  a 
neurologic  nature,  requiring  methods  of  a  nerve-stimulating  char- 
acter, rather  than  strictly  local  or  cataphoric  applications.  Where  the 
derangements  are,  on  the  contrary,  accompanied  or  caused  by  physi- 
cal changes  in  the  uterus  or  adjacent  organs  a  method  aiming  at 
correcting  the  local  conditions  is  essential.  Owing  to  the  nerve-rela- 
tionships of  this  function,  it  will  be  found  that  any  extensive  electric 
treatment  of  any  portion  of  the  body,  at  or  near  the  menstrual  moli- 
men,  will  tend  to  increase  or  hasten  the  flow,  and  particularly  is  this 
true  of  intra-uterine  galvanic  treatment,  during  which  it  is  well  to 
warn  the  patient  of  this  peculiarity.  T\Tiere  no  abnormality  of  men- 
struation exists,  therefore,  it  is  well  to  intermit  general  electric  treat- 
ment of  any  character  during  the  period,  unless,  indeed,  it  is  desired 
to  increase  its  duration  or  amplitude. 

Amenorrhea. — In  the  irregularly-appearing,  deficient,  or  sup- 
pressed periods  of  young  girls  just  entering  womanhood  the  abdomino- 
dorsal  application  of  either  the  galvanic  or  faradic  current,  negative 
to  abdomen,  is  particularly  indicated  (preferably  the  galvanic),  the 
slight  exposure  of  the  person  freeing  it  from  objections  inherent  in 
any  other  method.  It  is,  of  course,  incumbent  on  the  physician  to 
inquire  closely,  so  far  as  possible,  into  the  causes  of  the  irregularity, 
and  to  institute  additional  means  for  their  removal.  Sedentary  habits, 
overstudy,  deficient  assimilation  of  food,  and  particularly  autointoxi- 
cation from  accumulated  secretions  within  tlie  alimentary  canal,  will 
(72) 


MENSTRUAL    DERANGEMENTS.  73 

most  often  be  found  to  be  the  causes  that  lead  to  irregularity  in  the 
development  of  the  sexual  organs,  and  these  must  receive  appropriate 
attention.  In  certain  cases,  however,  the  suppression  occurs  in  other- 
wise healthy  and  even  robust  individuals  as  a  result  of  mental  or 
climatic  influences  or  a  change  of  environment,  as  when  a  girl  re- 
moves from  the  country  to  the  city  or  goes  on  shipboard  to  a  new 
country.  I  have  even  noted  such  irregularity  in  the  case  of  a  girl 
who  went  south  from  Philadelphia  to  a  more  rural  section.  In  the 
former  case  electricity  should  be  conjoined  with  the  other  indicated 
remedial  procedures;  in  the  latter  it  will  be  sufficient  alone,  as  the 
nervous  system  is  mainly  at  fault.  Whether  the  suppression  be  due 
to  a  general  debility  or  to  a  mere  disarrangement  of  the  nerve-forces, 
a  stimulation  of  the  neuro-vascular  processes  in  the  pelvis  is  most 
beneficial.  The  current  should  be  thoroughly  applied  to  the  abdomi- 
nal and  pelvic  sympathetic  plexuses  and  to  the  lumbar  enlargement. 
The  patient  lying  upon  the  large  pad,  the  round  pad  should  be  applied 
alternately  to  the  epigastrium  and  hypogastrium,  from  50  to  100 
milliamperes  being  employed,  of  the  galvanic  current,  followed  by  a 
strong  primary  faradic.  There  are  very  few  cases,  indeed,  that  resist 
strong  currents  thus  applied,  though  vaginal  and  intra-uterine  appli- 
cations may  exceptionally  be  required  as  a  still  stronger  stimulus  to 
the  nervous  processes  of  the  pelvis.  The  active  pole  in  the  latter 
applications  should  invariably  be  negative,  on  account  of  its  marked 
congesting,  stimulating,  and  moisture-attracting  powers. 

Not  a  little  of  the  benefit  derived  from  the  external  applications 
in  these  cases  is  due  to  the  correction  of  the  constipation  and  imper- 
fect chylopoiesis,  which  is  usually  responsible  for  the  condition. 

Scanty  Menstruation. — If  electricity  at  times  is  only  an  adjuvant 
to  tonics  and  laxatives  in  the  amenorrhea  of  weakly  girls,  it  may,  on 
the  other  hand,  be  regarded  as  an  all-sufficient  reliance  in  the  scanty 
menstruation  of  mature  women.  This  latter  condition  is  frequently 
associated  with  neurasthenia,  both  in  women  of  slight  build  and  in 
those  who  are  becoming  too  fleshy.  The  normal  tidal  wave  of  func- 
tionation  is  deficient  in  both,  resulting  in  an  "edginess"  of  the  nerves 
that  renders  the  patient  miserable  for  a  week  or  more  in  each  month, 
or  else  permits  her  to  take  on  fat  by  an  accumulation  of  reserve 
material  that  would  otherwise  be  thrown  off,  as  suggested  by  Lap- 
thorn  Smith.  In  these  cases  we  may  employ  simple  bipolar  faradic 
currents  from  the  fine  wire  to  the  uterus  or  vagina  as  a  nerve-stimulus, 


74  DISEASES    OF    WOMEN. 

as  recommended  by  a  number  of  writers,  or  the  negative  galvanic  cur- 
rent to  the  vaginal  surface  of  the  uterus  or  to  the  cavity  as  I  usually 
prafer,  employing  from  10  to  20  milliamperes.  A  good  plan  is  to 
alternate  the  galvanic  and  faradic  applications,  the  galvanic  being 
applied  every  two  or  three  days. 

Both  currents  are  indicated  in  the  attraction  of  blood  and  nerve- 
force  to  the  pelvis,  and  some  patients  will  quickly  notice  a  relief  in 
the  symptoms  of  cerebral  fullness  and  discomfort,  which  they  rightly 
attribute  to  the  scanty  flow,  even  before  the  appearance  of  the  next 
period.  From  what  has  been  said  of  the  effect  of  any  electric  appli- 
cation on  the  period  it  will  be  seen  that  this  treatment  should  be 
continued  until  the  actual  appearance  of  the  period,  and  may  even 
be  applied  after  its  appearance,  to  intensify  the  effect. 

A  striking  illustration  of  the  effect  of  an  increased  flow  on  the 
nervous  system  was  observed  in  my  practice  recently  in  the  case  of  a 
lady  who  had  suffered  from  cerebrasthenic  symptoms  for  several 
years,  associated  with  nervous  dyspepsia,  scanty  menstruation,  and 
sterility.  The  uterus  was  retroverted,  but  otherwise  healthy.  Com- 
plete rslief  of  the  gastric  symptoms  did  not  relieve  the  monthly 
accession  of  irritability  until  treatment  was  applied  to  the  pelvis. 
One  negative  intra-uterine  application  a  few  days  before  each  period 
brought  on  a  satisfactory  flow  with  the  desired  relief. 

Menorrhalgia. — Menstrual  pain;  dysmenorrhea. — The  list  of 
pathologic  views  that  have  been  advanced  in  accounting  for  what  is 
usually  called  dysmenorrhea  is  somewhat  extended,  even  when  the 
term  is  restricted  to  the  uterine  type  of  painful  menstruation,  exclud- 
ing ovarian  and  inflammatory  pains  and  true  neuralgia.  Those  most 
prevalent  at  the  present  time  are,  on  the  one  hand,  the  mechanical 
theory  of  obstruction  from  stenosis  or  flexion,  which  may  be  called 
the  Marion-Sims  theory,  and,  on  the  other  hand,  the  parametritic 
theory  of  Schultze.  As  to  the  first,  it  is  not  sufficiently  well  known 
that  this  latter  observer  has  completely  upset  the  obstructive  or  me- 
chanical theory  by  demonstrating  that  a  sound  may  be  passed  during 
the  crisis  of  a  supposed  example  of  accumulation  without  encounter- 
ing fluid:  an  observation  which  I  have  verified  on  a  number  of  occa- 
sions. In  several  instances  in  which  I  have  made  intra-uterine  appli- 
cations during  great  pain  the  cervix  was  found,  on  the  contrary,  to  be 
distinctly  more  dilated  than  at  other  times.  The  obstruction  theory 
is  also  weakened  by  the  examples  of  stenosis  and  anteflexion  that 


MENSTRUAL    DEKANGExMENTS.  75 

occur  without  painful  menstruation.  Yet  Schultze's  theory  of  para- 
or  peri-  metric  inflammation  as  a  cause  is  not  by  any  means  satis- 
factory. That  it  has  failed  of  practical  acceptance  by  those  even  who 
advocated  it  is  shown  by  their  adherence  to  dilatation  as  a  means  of 
cure. 

In  that  excellent  picture  of  painful  menstruation  contributed  by 
W.  Gill  Wylie  to  the  "American  System  of  Gynecology"  another 
pathologic  condition  is  suggested:  hyperesthesia  of  the  endometrium. 
That  an  hyperesthetic  condition  of  the  cavity  does  exist  in  these  cases 
I  think  anyone  who  has  passed  a  sound  into  them  will  admit.  The 
exclamations  of  pain  when  the  internal  os  is  passed  are  most  char- 
acteristic^ and,  in  cases  where  a  proper  gentleness  has  been  observed, 
must  be  other  than  normal;  yet  there  are  certain  facts  which  indicate 
tbat  hyperesthesia  is  but  one  of  the  conditions  present.  In  a  typical 
attack  of  painful  menstruation  the  first  thing  to  appear  is  the  pain, 
which  precedes  the  flow  by  an  appreciable  interval.  How  a  mere 
hyperesthesia  of  the  endometrium  can  explain  this  does  not  appear 
clear.  In  the  great  majority  of  such  cases  the  pain  ceases,  in  part 
or  altogether,  after  the  flow  has  been  established,  and  it  is  this  fact 
particularly  which  has  intrenched  the  believers  in  the  purely  mechan- 
ical or  obstructive  nature  of  the  trouble,  which,  in  its  boldest  form, 
attributes  the  pain  to  a  damming  up  of  the  menstrual  fluid  by  a  too 
narrow  outlet,  through  which  it  is  forced  by  a  "mimic  labor."  To 
Schultze's  demonstration  of  the  absence  of  an  accumulation,  which 
is  corroborated  by  an  absence  of  dilatations  above  the  alleged  strict- 
ure, may  be  added  another  argument  against  this  latter  view,  in  the 
fact  that  analogous  conditions  of  stricture,  as  in  the  male  urethra, 
are  not  attended  by  premonitory  pains,  but  by  greatest  pain  during 
the  actual  flow.  The  "mimic-labor"  illustration  is  inappropriate  for 
the  same  reason.  Finally,  the  non-existence  of  a  fibrous  mechanical 
stricture  is  proven  by  the  fact  that  ether  will  relax  the  apparently 
stenotic  internal  os  sufficiently  to  permit  a  large  dilator  to  be  inserted. 

A  better  explanation  of  the  etiology  of  painful  menstruation  is 
that  which  regards  it  as  almost  entirely  a  neuro-muscular  phenome- 
non. The  attempt  at  the  performance  of  an  important  function  while 
either  the  nerve-centres  in  the  cord  or  the  uterus  itself  are  in  an 
unprepared  condition  results  in  pain.  If  the  trouble  is  in  the  uterus 
the  pains  assume  a  nature  that  the  patients  themselves  have  accurately 
described   as   "cramps."     In   a  paper  read   before   the   Philadelphia 


76 


DISEASES    OF    WOMEN. 


Obstetric  Society,  December  5,  1889,  the  author  proposed  for  this 
condition  the  name  of  a  "menorrhspasm."  That  the  spasm  alone  is 
the  parent  of  the  pain  rather  than  retained  excretion  is  more  than 
likely,  an  associated  sequence  being  an  inhibition  of  the  excretory  act 
until  relaxation  has  occurred. 

Menorrhspasm,  in  brief,  may  be  said  to  be  a  neuro-myotic  storm 
of  the  uterine  neuro-muscular  apparatus,  which  renders  the  excretion 
of  the  menstrual  fluid  temporarily  impossible.  Its  exciting  cause  may 
be  either  lack  of  development  of  the  organ  or  morbid  conditions  of 
the  endometrium,  while  its  remote  causes  are  traceable  to  all  those 
influences  in  modern  society  which  hinder  the  proper  development  of 
animal  life  in  young  women. 

That  a  spastic   muscular  contraction,   most  noticeable   at  the 


Fig.  29. — Section  of  uterus  made  at  os  internum  {ad  nat.),  showing  the 

normal  size  of  the  os  internum,  the  circular  disposition  of  the  fibres 

around   it,   and  the   blood-vessels  in   proximity.      (Barnes.) 


internal  os,  usually  accompanies  the  menorrhspasm  is  undoubted,  and 
there  is  reason  to  believe  that  the  contraction  may  be  excited  by 
the  sound  between  the  periods.  The  predominance  of  circular  fibres 
at  the  internal  os,  which  is  clearly  shown  in  the  accompanying  cut 
(Fig.  29)  from  Barnes's  "Diseases  of  Women,"  offers  a  ready  explana- 
tion of  this. 

If  such  views  of  this  condition  are  correct,  it  becomes  evident  at 
once  that  a  better  name  than  "dysmenorrhea"  (difficult  menstruation) 
should  be  used  in  describing  it,  particularly  since  this  term  at  once 
suggests  mechanical  conditions  only,  with  the  harsh  treatment  appro- 
priate to  such.  At  the  meeting  referred  to,  the  author,  while  advo- 
cating the  view  that  the  causative  condition  was  a  menorrhspasm, 
urged  the  general  use  of  the  merely  symptomatic  designation,  "menor- 


MENSTRUAL    DEEANGEMENTS.  77 

rhalgia"  (menstrual-flow  pain)  in  ^areference  to  "dysmenorrhea,"  as, 
in  itself,  involving  no  theory. 

Accepting  the  neuro-muscular  view  of  the  cause  of  these  pains, 
the  oneness  of  the  pathologic  condition  in  all  cases  is  at  once  apparent, 
the  differences  being  only  matters  of  degree.  In  the  one  case,  the 
neuro-myotic  storm  is  but  a  danger-signal  pointing  to  a  neurotic  con- 
stitution, vasomotor  disturbances,  spinal  irritation,  abdominal  tor- 
pidity, or  even  merely  habitual  constipation;  the  attempt  at  the  per- 
formance of  a  high  function  in  the  presence  of  these  disabling  con- 
ditions resulting  in  pain.  Given  a  high  degree  of  uterine  neuro-mus- 
cular incapacity  and  the  spastic  spasm  occurs  in  the  absence  of  these 
allied  conditions,  rendering  direct- local  treatment  imperative  for  its 
relief. 

We  have,  then,  a  simple  and  convenient  division  of  cases  of 
menorrhalgia  into  those  not  requiring  local  treatment  and  those  in 
which  local  treatment  is  necessary.  The  dictates  of  common  sense 
unite  with  the  high  obligations  of  the  physician  in  urging  him  to 
assign  all  cases  of  menorrhalgia  in  virgins  to  the  former  class,  at  least 
until  he  has  demonstrated  by  a  failure  of  general  methods  that  a  local 
examination  is  imperative.  The  author  cannot  too  strongly  condemn 
the  general  habit  of  hasty  examination  in  these  cases,— a  habit  that 
is  a  direct  sequence  of  the  ultramechanical  views  of  the  day. 

For  practical  purposes  a  still  further  division  of  cases  requiring 
local  treatment  is  wise,  since  some  cases  are  either  due  to,  or  accom- 
panied by,  catarrhal  conditions  yet  confined  to  the  uterus,  while  others 
present  manifest  congestion,  inflammation,  or  other  morbid  conditions 
of  the  ovaries. 

Nervous  Menorrhalgia. — Menorrhalgia  of  the  lesser  degree,  and 
even  the  most  painful  form,  when  accompanied  by  derangements  of 
the  nervous  system  or  of  the  abdominal  viscera  and  unaccompanied 
by  organic  uterine  disease,  is  best  treated  by  percutaneous  galvanic 
applications,  abdomino-dorsal,  or  even  merely  spinal,  the  dose  varying 
from  10  to  60  milliamperes,  pro  re  nata.  Large,  well-moistened  elec- 
trodes, and  the  gradual  manner,  without  shocks,  should  be  used. 

In  addition  to  many  cases  of  pronounced  menorrhalgia  relieved 
by  external  treatment,  I  have  a  large  number  of  instances  recorded 
in  my  notes  where  young  girls  undergoing  spinal  applications  of  the 
galvanic  current  for  different  objects  have  volunteered  the  informa- 
tion that  various  amounts  of  menstrual  pain  had  disappeared  while 


78  DISEASES    OF    AVOMEN. 

under  treatment.  These  cases  generally  improve  in  blood  and  weight 
also,  but  I  have  seen  numerous  instances  where  the  lessening  of  the 
pain  preceded  any  possible  influence  on  the  general  health,  being 
found  in  a  period  coming  on  but  a  few  days  after  the  beginning  of 
the  applications. 

A  systematic  treatment  of  this  sort  should  consist  of  thrice- 
weekly  or  daily  applications,  beginning  at  the  termination  of  a  period 
and  lasting  until  the  next  flow  has  appeared.  Two  months  of  such 
treatment,  combined  with  proper  means  for  the  regulation  of  the 
bowels,  if  required,  will  usually  be  sufficient  to  make  a  permanent 
cure. 

Uterine  Menorrhalgia. — In  spite  of  most  careful  treatment,  never- 
theless, many  cases  present  a  menorrhspasm  of  so  pronounced  a  local 
character  that  nothing  short  of  direct  treatment  will  be  of  service. 
The  frequent  association  of  endometritis  is  also  a  determining  fact  in 
favor  of  local  treatment.  It  is  in  these  pronounced  cases  that  dilata- 
tion has  been  of  service,  the  possible  explanations  of  its  action  includ- 
ing an  alterative  effect  on  the  endometrium  and  the  trophic  condition 
of  the  organ,  as  well  as  the  mere  paral3'zing  effect  of  the  divulsion. 

In  my  experience  a  more  certain  and  less  formidable  remedy 
for  these  intractable  cases  of  uterine  menorrhalgia  may  be  found  in 
the  intra-uterine  action  of  one  pole  of  the  galvanic  current, — usually 
the  negative  pole  when  a  promotion  of  flow  is  also  desired,  or  the 
positive  pole  if  the  endometritis  be  pronounced, — the  strength  vary- 
ing from  15  to  50  milliamperes,  pro  re  naia.  From  two  to  six  appli- 
cations may,  at  times,  be  sufficient,  extending  over  one  or  two  inter- 
menstrual periods.  As  contrasted  Avith  forcible  dilatation,  this  method 
is  simple,  free  from  danger,  does  not  require  an  anesthetic,  and  may 
be  employed  in  young  girls  without  the  use  of  a  speculum.  The 
following  typical  case  may  be  cited  as  an  illustration: — 

liliss  A.  C,  aged  24.  Puberty  at  13.  Menstruation  regular, 
normal  in  amount,  always  extremely  painful.  No  leucorrhea  nor 
intermenstrual  pain.  The  menorrhalgia  presented  the  usual  char- 
acteristics, accompanied  by  hyperesthesia  of  back  and  abdomen  and 
pains  down  the  limbs,  and  had  been  markedly  increasing  for  the  last 
six  months.  As  she  was  constipated,  a  course  of  laxatives  and  lumbo- 
abclominal  galvanic  applications  was  followed  for  one  month  without 
effect.  Examination  then  revealed  a  small  uterus  with  fundus  for- 
ward, OS  virginal,  and  appendages  healthy.     After  patient  efforts  an 


MENSTRUAL    DERANGEMENTS.  79 

electrode  was  inserted  to  the  internal  os  only,  and  25  milliamperes, 
negative,  applied  for  two  minutes. 

Six  days  later  the  sound  went  to  the  fundus  with  but  little 
trouble,  and  40  milliamperes  were  used.  The  ensuing  period  was  less 
painful,  permitting  sleep  for  the  first  time  in  months  during  a  men- 
strual period.  The  sound  now  entered  with  ease,  and  two  more  appli- 
cations were  made,  followed  by  a  perfectly  painless  period.  Six 
months  later  the  patient  reported  perfect  health  and  continued  im- 
munity from  pain. 

Such  a  case  is  clearly  an  instance  of  lack  of  completeness  in  de- 
velopment, and  it  is  very  likely  that  faradic  currents  would  have  been 
equally  successful  in  the  treatment. 

But  by  far  the  larger  number  of  cases  of  so-called  dysmenorrhea, 
or  menorrhalgia,  are  really  instances  of  endometritis  with  menor- 
rhalgic  symptoms,  and  in  these  cases  the  ease  of  cure  under  electricity 
is  no  less  an  arraignment  of  the  harsh  methods  of  treatment  by  forced 
dilatation  than  the  instances  in  which  stenosis  is  one  of  the  incidents 
of  lack  of  development.  Case  after  case  has  been  sent  to  me  after 
thorough  dilatation  has  been  fruitlessly  used  in  which  the  only  evi- 
dence of  organic  abnormality  that  existed  at  any  time  was  a  catarrh 
of  the  endometrium.  When  these  cases  can  be  cured  by  from  one  to 
a  dozen  applications  without  mutilating  and  cicatrizing  the  uterine 
mouth  it  is  high  time  that  such  illogical  procedures  should  be  rele- 
gated to  the  obscurity  of  an  historic  fad.  Certain  electro-therapeutists 
even  are  not  free  from  the  influence  of  this  disproven  theory  of  ob- 
struction, for  they  recommend  electric  dilatation  with  a  series  of 
graduated  bulbs  as  the  negative  electrode.  If  there  is  any  need  of 
dilatation  this  is,  of  course,  the  typical  method,  but  I  myself  never 
have  occasion  to  employ  any  kind  of  dilatation  in  the  treatment  of 
these  cases,  unless  the  use  of  an  ordinary  sound-shaped  electrode  may 
be  so  called.  Any  case  that  can  readily  admit  such  an  electrode  is 
amply  large  for  any  flow,  and  the  passage  of  clots  is  best  treated  by 
the  cure  of  the  causative  endometritis.  This  statement  of  the  required 
calibre  of  the  cervical  canal  is  not  based  on  actual  measurements,  but 
upon  the  uniformly  successful  results  of  a  large  series  of  cases  treated 
by  electricity  administered  from  an  instrument  of  the  same  size  (that 
of  the  Simpson  sound)  and  without  other  dilatation  than  this  instru- 
ment might  produce.  There  has  not  been  a  single  instance  of  failure 
to  cure. 


80  DISEASES    OF    WOMEN. 

A  cervix  with  the  characteristic  jDin-hole  os,  with  or  without  a 
contracted  internal  os,  is  unquestionably  atresic,  it  is  true,  but  this  is 
only  one  symptom  of  a  general  sexual  maldevelopment.  A  painstak- 
ing insertion  of  an  ordinary  electrode,  assisted,  at  times,  by  10  milliam- 
peres,  negative,  before  it  slips  past  the  internal  os,  and  the  adminis- 
tration of  from  15  to  30  milliamperes,  negative,  will,  if  repeatedly 
employed,  so  lessen  the  hyperesthesia  and  increase  the  nutrition  that 
the  better-developed  uterus  will  admit  the  sound  easily  and  almost 
painlessly,  and  painless  periods  will  follow. 

"When  the  case  is  cle^irly  one  of  virginal  endometritis,  of  which 
the  chief  symptoms  are  the  menorrhalgia  and  a  leucorrheal  discharge, 
the  intra-uterine  galvanic  treatment  is  indispensable,  but  the  positive 
pole  should  be  employed,  with  from  15  to  -40  milliamperes,  twice  a 
week.  When  the  os  is  suffice' ently  patulous  to  admit  an  elastic  elec- 
trode far  less  discomfort  will  follow  its  use  than  the  stiff  instrument, 
and  it  is  even  better  to  cover  the  bare  surface  of  the  spiral  lightly  with 
absorbent  cotton  dipped  in  hot  water  and  soaped  if  the  additional  bulk 
will  not  be  too  great  for  its  insertion.^  At  the  end  of  the  five  minutes 
devoted  to  this  current  and  before  withdrawing  the  electrode  a 
faradic  current  should  be  turned  on  from  a  medium  secondary  coil, 
strong  enough  to  be  distinctly  felt  by  the  patient.  The  finger  should 
always  support  the  cervix  at  the  moment  of  removing  a  cotton-covered 
electrode  from  the  cavity,  as  it  is  apt  to  be  somewhat  tightly  clasped 
by  the  uterus,  causing  the  latter  to  be  dragged  downward.  When  the 
catarrh  is  confined  to  the  body  alone  it  is  generally  impossible  to  insert 
so  bulky  an  instrument  as  a  cotton-covered  electrode,  the  folds  of  the 
cervical  mucous  membrane  being  ^apable  of  being  eluded  only  by  the 
painstaking  use  of  the  stiff  instrument  curved  to  suit  the  case. 

The  following  typical  cases  illustrate  the  details  of  treatment: — 

Miss  A.  D.,  aged  24,  referred  by  Dr.  Woodbury,  gave  a  typical 
history  of  menorrhalgia  with  endometritis  dating  from  puberty.  Ex- 
ternal treatment  failing  to  relieve  her,  an  examination  was  made  and 
the  uterus  found  exuding  considerable  mucus,  though  small  and  ante- 
flexed.  The  internal  os  was  small  and  admitted  the  sound  with  diffi- 
culty. Twenty-five  milliamperes,  positive,  were  given  for  five  minutes 
on  April  29th.    Five  days  later  40  milliamperes  were  given;  on  May 


'  The  appearance  of  the  cotton  after  removal  of  the  electrode  will  also  be 
a  material  aid  in  diagnosing  the  condition  and  progress  of  the  case. 


MENSTEUAL    DERANGEMENTS.  81 

7tli  the  flow  came  on  several  days  ahead  of  time  with  much  less  pain. 
During  the  next  intermenstrual  period  two  applications  of  40  milliam- 
peres^  positive,  were  administered,  and  at  the  next  ensuing  period  the 
patient  was  entirely  free  from  pain  or  discomfort,  and  no  leucorrhea 
followed  it.  jSTo  treatment  was  given  this  month,  but  the  next  period, 
being  slightly  painful,  two  more  application  were  made,  resulting  in 
a  permanent  cure. 

Miss  P.,  aged  22,  was  referred  to  me  by  Dr.  Egbert  H.  Grandin, 
of  Few  York,  who  had  ineffectually  used  dilatation.  Pain  continued 
constant  and  at  periods  intense,  requiring  her  to  remain  in  bed.  Ex- 
amination showed  an  enlarged  uterus,  free  leucorrhea,  and  tenderness 
of  left  ovary.  She  received  six  applications  of  30  milliamperes,  posi- 
tive, to  the  cavity  during  two  intermenstrual  periods,  resulting  in 
complete  relief.     Six  months  later  she  was  well  and  gaining  in  flesh. 

Miss  R.,  aged  20,  was  referred  to  me  by  Dr.  Bayliss,  of  Knoxville, 
Tenn.  Since  a  delayed  puberty  at  16  she  had  always  been  menor- 
rhalgic.  The  pain  is  worse  after  the  flow  begins,  and  during  its  height 
she  "wants  to  die."  A  pain  persists  in  the  thighs  between  periods. 
On  admission  to  the  sanatorium  examination  showed  the  uterus,  with 
the  slight  enlargement  usual  in  these  cases,  tender  and  deviated  to 
the  right.  A  copious  leucorrhea  existed.  She  received  intra-uterine 
applications  of  20  to  25  milliamperes,  positive,  February  16th  and 
March  5th,  1-ith,  20th,  and  24th,  accompanied  by  daily  general  gal- 
A^anic  treatment  for  the  nervous  symptoms.  The  treatment  was  inter- 
rupted at  this  time  by  the  patient's  presence  being  necessary  at  home, 
and,  though  considerable  improvement  persisted  for  a  time,  there  was 
a  return  of  leucorrhea,  with  some  pain,  a  year  later.  The  result  Avould, 
doubtless,  have  been  perfect  had  stronger  galvanic  currents  been  used, 
assisted  by  local  faradic  treatment. 

Miss  S.,  aged  20,  had  for  several  years  had  an  increasing  leucor- 
rhea with  a  menorrhalgia  that  was  becoming  worse.  The  uterus  was 
normal  except  for  a  muco-purulent  catarrh  and  hyperesthetic  cavity. 
Five  applications  of  30  milliamperes  were  made  to  the  cavity,  result- 
ing in  a  perfect  cure,  verified  by  five  3'ears'  subsequent  observation. 
One  of  the  earlier  applications  was  made  during  the  early  hours  of  a 
period  and  the  interesting  fact  observed  thst  the  uterus  was  more 
patulous  than  usual  at  the  beginning  of  the  flow  in  spite  of  intense 
cramps,  thus  adding  another  proof  that  the  pain  in  these  cases  is  not 
due  to  obstruction. 

0 


82  DISEASES    OF    AVOMEX. 

Miss  H.,  aged  2o,  admitted  from  Wilmington,  Del.  This  young 
lady  was  mucli  reduced  in  health  by  a  moderate  uterine  catarrh  with 
menorrhalgia  that  had  kept  her  in  bed  one  day  of  each  month  for  ten 
years  and  in  an  exhausted  condition  one  week  in  each  month  for  some 
time.  The  softened,  eroded  os  and  enlarged  uterus  required  the  touch 
only  to  establish  a  satisfactory  diagnosis.  The  treatment  was  with 
both  currents  intra-uterine,  the  galvanic  current  usually  being  35 
milliamperes.  The  use  of  cotton  on  an  elastic  electrode  was  prac- 
ticable, and  the  progressive  improvement  was  well  shown  by  the 
gradual  improvement  in  the  appearance  of  the  cotton  after  removal, 
the  earlier  applications  leaving  it  saturated  with  bloody  mucus.  The 
cure  was  complete,  and  attested  by  quite  a  change  in  her  appearance. 

It  has  been  my  fortune  to  have  had  under  similar  observation  and 
treatment  some  fourteen  other  cases  of  the  same  character,^  and  it  is 
not  too  much  to  say  that  they  were  all  surely  rescued  from  a  slowly 
impending  invalidism  for  which  an  unsexing  operation  would  have 
been  advised  when  the  tubes  and  ovaries  had  become  involved. 

Ovarian  MeJiorrlialgia. — So  much  for  the  neural  and  uterine 
forms  of  menorrhalgia.  But  it  should  be  understood  that  some  cases 
are  distinctly  ovarian  in  origin,  and  by  this  is  meant  that  the  process 
described,  of  a  neural  predisposition  and  catarrhal  aggravation,  has 
proceeded  so  far  as  to  finally  involve  the  ovaries  in  organic  changes, 
—usually  of  a  merely  congestive  character,  but  none  the  less  organic. 
In  these  cases  any  intra-uterine  treatment  should  be  carefully  avoided 
and  reliance  placed  on  the  applications  described  elsewhere  for  ovarian 
congestion  or  ovaritis.  Such  cases  may  be  detected  by  noting  that  the 
patient  has  an  intermenstrual  tenderness,  and  on  examination  presents 
the  characteristic  bogginess  in  the  ovarian  regions.  Yet  it  is  not 
always  possible  to  clearly  distinguish  between  the  cases  that  are  of 
uterine  origin  and  those  in  which  the  ovaries  are  involved,  for  the 
evident  reason  that  the  uterine  seat  of  the  trouble  frequently  persists 
after  the  case  has  developed  ovarian  S}Tnptoms  from  neglect  or  rash 
treatment,  and  in  this  predicament  we  must  rely  mainly  on  the 
vaginal  applications  recommended  in  ovaritis  and  salpingitis,  inter- 
spersed with  such  g'entle  intra-uterine  applications  as  the  progress  of 


'  American   Gynecological   and   Obstetrical   Journal,   page   201,   February, 
1896. 


MENSTRUAL    DERANGEMENTS.  83 

the  case  will  warrant.  The  following  case  is  a  good  illustration  of 
this  difliciilty: — 

Miss  ,  aged  18,  had  been  dilated  one  year  previously  by  a 

prominent  surgeon,  under  ether,  she  having  entered  a  hospital  for  that 
purpose.  This  not  only  failed  to  relieve  her,  but  apparently  trans- 
formed a  simple  uterine  menorrhalgia  into  an  ovarian  menorrhalgia, 
since  there  had  been  a  constant  intermenstrual  pain  since  the  oper- 
ation which  she  did  not  have  before,  and  under  which  her  general 
health  was  breaking  down.  She  was  placed  on  vagino-abdominal 
applications  of  both  currents  until  the  intermenstrual  pain  should  be 
controlled,  which  did  not  occur  for  at  least  three  months.  During 
this  time  there  was  little  or  no  abatement  of  the  menorrhspasms  them- 
selves in  spite  of  a  general  restoration  of  health.  Intra-uterine  posi- 
tive applications  of  25  milliamperes  were  now  made  three  times  a 
month,  with  complete  cure  after  three  additional  months.  This  lady 
has  since  married  a  professional  colleague  and  remains  in  excellent 
health. 

Menorrhagia  and  Metrorrhagia. — An  inordinate  flow  at  the 
periods,  if  persistent,  is  usually  due  either  to  an  endometritis,  to  re- 
tained shreds  of  tissue  from  a  miscarriage,  or  to  neoplasms.  When  due 
to  either  of  the  latter  causes,  the  flow  partakes  of  the  character  of  a 
metrorrhagia,  and  may  appear  between  the  periods  or  even  be  con- 
stant. 

There  are,  nevertheless,  a  sufficient  number  of  instances  of  simple 
menorrhagia  unaccompanied  by  leucorrhea  in  young  girls,  evidencing 
laxity  of  tissue  and  vasomotor  disturbance.  Internal  medication 
and  hygienic  regulation  is  usually  indicated  in  these,  and  is  ordi- 
narily successful.  There  is  also  a  type  of  persistent  menorrhagia 
without  leucorrhea  in  married  women,  of  what  might  be  said  to  be 
an  uncertain  origin,  in  which  the  intra-uterine  application  of  the  posi- 
tive pole  is  urgently  indicated.  The  following  case  is  an  excellent 
example  of  this: — 

The  wife  of  a  clergyman,  aged  29,  was  referred  to  me  by  Dr.  G.  H. 
Whitcomb,  of  Greenwich,  IST.  Y.,  with  the  statement  that  she  had  been 
greatly  relieved  of  pelvic  tenderness  and  uterine  fixation  by  the  use 
of  electricity  in  his  own  hands.  She  had  been  menorrhalgic  for  some 
years  before  marriage,  which  had  occurred  five  years  before  seeing 
me,  and  had  never  been  pregnant.     Of  late  the  pain  had  become  ex- 


84  DISEASES    OF    WOMEN. 

cessive  and  the  flow  very  profuse,  requiring  her  to  keep  her  bed  during 
the  period.    There  was  no  leucorrhea. 

Examination  revealed  a  slightly  enlarged  uterus  in  good  posi- 
tion and  moderately  movable.  The  cavity,  within  which  a  sound  was 
inserted  with  difficulty,  was  capacious  and  three  inches  deep.  She 
was  placed  upon  intra-uterine  applications  of  20  to  30  milliamperes, 
positive,  followed  by  the  secondary  current,  alternating  with  vaginal 
applications  of  50  to  60  milliamperes.  She  did  well  on  these  when 
not  too  frequently  applied,  and  after  a  half-dozen  treatments  was 
much  improved.  The  intra-uterine  applications  were  now  continued 
exclusively,  once  a  month,  as  the  lady  was  now  residing  near  the  city, 
ten  such  treatments  being  given  during  the  continuance  of  a  pro- 
gressive improvement.  The  treatment  was  finally  interrupted,  much 
to  our  common  surprise,  by  the  evidences  of  pregnancy,  which  has 
since  gone  on  to  a  happy  termination. 

This  case  was  under  treatment  prior  to  my  discovery  of  the  value 
of  zinc-amalgam  cataphoresis  in  hemorrhagic  conditions  of  the  uterus. 
A  cure  could  undoubtedly  have  been  obtained  by  this  method  in  one- 
half  of  the  time,  or  possibly  less. 

The  electric  treatment  of  persistent  metrorrhagia  from  causes 
local  to  the  uterus,  of  whatever  nature,  is  one  of  the  most  valuable 
procedures  introduced  by  Apostoli,  and  it  is  extremely  rare  to  find  a 
case  that  will  resist  the  thorough  application  of  the  positive  pole 
as  directed  by  him.  An  essential  feature  of  his  method  as  applied 
to  an  intractable  case  is  the  direction  given  that  every  portion  of  the 
endometrial  surface  should  be  placed  in  contact  with  the  electrode  in 
order  that  the  peculiar  hemostatic  action  of  this  pole  should  be  made 
to  reach  all  portions  of  the  bleeding  surface.  The  immediate  effect 
of  the  positive  pole  thus  applied  is  distinctly  hemostatic,  as  may  be 
demonstrated  under  the  eye  in  any  superficial  bleeding  surface,  but  it 
is  also  necessary  that  the  secondary  alterative  effect  of  the  mildly 
escharotic  action  should  also  be  secured  in  all  portions  of  the  mucosa 
of  the  uterine  body.  In  order  that  this  may  be  properly  accomplished 
Apostoli  advises  that  bulbous  electrodes  of  carbon  be  used,  the  active 
surface  being  two  centimetres  long  and  of  various  sizes,  in  order 
that  the  physician  may  select  the  largest  size  that  can  be  inserted. 
The  one  selected  is  carried  to  the  fundus  attached  to  the  positive 
pole  of  the  battery  and  a  current  of  50  to  80  milliamperes  turned 
on  for  some  minutes;  tlio  current  is  then  turned  off  and  the  instru- 


MENSTRUAL    DERANGEMENTS.  85 

ment  withdrawn  to  the  length  of  the  active  surface,  wliich  may  be 
easily  ascertained  by  the  finger  at  the  os  if  the  shank  is  marked  at 
appropriate  distances,  and  the  current  again  turned  on  and  the  instru- 
ment kept  immovable  for  another  period  of  three  or  four  minutes. 
This  procedure  is  repeated  until  the  bulb  impinges  on  the  internal  os. 
The  cervical  cavity  itself  should  not  receive  an  application  in  ordinary 
cases. 

The  author  has  greatly  improved  on  this  method  by  substituting 
amalgamated-zinc  bulbs  for  those  made  of  carbon  (Fig.  26),  per- 
mitting less  current  to  be  equally  effective,  and  the  application  be- 
comes, moreover,  thoroughly  antiseptic.  ISTo  other  change  in  the 
details  is  made.  The  particular  value  of  this  addition  to  the  Apostoli 
method  is  well  shown  in  the  following  typical  case: — - 

Mrs.  ,  aged  54,  was  referred  to  me  by  Dr.  H.  W.  Elmer,  of 

Bridgeton,  K.  J.,  April  17,  1894.  For  three  or  four  years  before 
admission  to  the  sanatorium  she  had  been  suffering  from  an  almost 
continuous  hemorrhage,  resulting  in  great  prostration.  Shortly  after 
the  beginning  of  the  hemorrhages  a  tumor  of  the  uterus  was  dis- 
covered, which  was  the  size  of  a  large  fist  when  I  first  saw  her.  She 
was  placed  under  the  Apostoli  treatment,  which  produced  consider- 
able improvement  in  the  hemorrhages,  but  did  not,  even  after  several 
weeks'  active  and  six  months'  occasional  treatment,  entirely  correct 
the  hemorrhagic  tendency.  Fearing  that  the  case  was  a  malignant 
one  in  spite  of  the  absence  of  marked  pain,  I  decided  to  substitute  an 
amalgamated-zinc  electrode  for  the  carbon  one  previously  employed. 
It  was  found  that  the  applications  with  this  electrode  were  better 
borne,  enabling  them  to  be  used  more  frequently.  Sis  applications 
were  made  in  a  period  of  two  weeks  in  December,  1894,  completely 
checking  the  dribbling,  and  since  then  there  has  been  no  real  hemor- 
rhage and  the  patient  has  been  restored  to  health.  The  tumor  was 
materially  reduced  in  size. 


CHAPTER  YIII. 

Cataeehal  Affections  of  the  Uteeo-Tubal  Mucous  Tract 
AXD  Theie  Consequences. 

The  Etiologic  TJnity  of  XJterine  and  Tubal  Catarrh. — ^It  is  of  the 

utmost  importance  in  estimating  the  value  of  a  conservative  treatment 
of  these  very  common  affections  to  recognize  the  fact  that  the  great 
majority  of  inflammatory  conditions  of  the  pelvis  are  primarily  due 
to  catarrh  of  the  utero-tubal  tract,  the  initial  lesion  being  a  catarrh 
of  the  uterus,  and  that  the  initial  seat  of  the  disease  is  apt  to  remain 
in  a  more  or  less  active  condition  during  the  prevalence  of  the  second- 
ary affections  in  the  tubes  and  ovaries.  It  is  a  belated  recognition  of 
this  fact  that  has  given  rise  to  the  prevalent  practice  among  surgical 
gynecologists  of  amputating  the  uterus  itself  after  subjecting  the 
patient  to  successive  operations  for  removal  of  one  and  of  both  ovaries 
and  tubes  without  relieving  the  suffering.  Were  such  cases  placed  on 
rational  treatment  for  the  initial  lesion  none  of  the  operations  would 
have  been  required,  and  a  great  multitude  of  women  would  be  saved 
to  their  families  and  to  a  normal  existence. 

The  strong  words  used  on  this  subject  of  the  wholesale  removal 
of  still  curable  ovaries  and  tubes  in  preceding  works  by  the  author 
received  criticism  in  certain  quarters,  but  have  never  been  contro- 
verted. It  must  still  be  said  with  regret  that  this  reprehensible  prac- 
tice of  destroying  important  organs  without  proper  efforts  to  cure 
them  is  by  no  means  on  the  wane. 

The  pessimistic  attitude  toward  the  curability  of  chronic  uterine 
catarrh  itself  has  even  taken  the  shape  of  a  denial  by  some  authorities 
of  the  abnormality  of  this  condition,  a  varying  amount  of  mucous  dis- 
charge being  said  to  be  natural  with  most  women.  This  is  physiologi- 
cally incorrect,  no  really  appreciable  discharge  being  ever  found  in 
a  healthy  person  except  in  association  with  erection.  The  degree 
of  departure  from  absolute  health  is  quite  accurately  indicated  by  the 
amount  and  character  of  a  persistent  discharge,  which,  though  con- 
stitutional onlv  in  certain  cases  of  anemic  girls,  in  every  other  instance 
(86) 


CATARRHAL    AFFECTIONS    OF    UTERO-TUBAL    TRACT.  87 

points  to  actual  local  disease  if  large  in  quantity  or  purulent,  and  is 
indicative  of  possible  extension  in  the  future  to  the  tubes  and  ovaries. 
Chronic  endometritis,  in  other  words,  not  only  leads  to  uterine  hyper- 
plasia, but  to  salpingitis  and  ovaritis  by  direct  transference  through 
continuity  of  structure.  The  most  common  diseases  of  the  appendages 
are,  therefore,  catarrhal  in  origin  and  secondary  to  catarrhal  inflam- 
mation of  the  uterine  mucous  tract,  not  even  exclusive  of  tuberculosis 
and  of  ectopic  gestation,  both  of  which  are  probably  invited  and  fixed 
by  an  inflammatory  nidus. 

For  practical  purposes,  particularly  for  an  intelligent  application 
of  electricity  to  the  exact  seat  of  the  disease,  it  is  necessary  to  continue 
the  division  of  endometritis  and  metritis  into  several  varieties,  each 
presenting  peculiarities  of  microscopic  and  macroscopic  appearances 
and  clinical  history  due  to  the  histologic  structure  of  the  particular 
organ  mainly  attacked  or  to  the  state  of  life  of  the  patient;  but  it 
should  be  stated  at  once  and  distinctly  that  the  views  now  held  by 
most  progressive  thinkers,  and  concurred  in  by  the  author,  class  all 
varieties  alike  as  microbic  in  real  character,  and  hence  pathologically 
identical,  except  as  varied  by  the  particular  microbe  concerned,  the 
local  structure  attacked,  and  the  stage  the  disease  has  attained. 

Beginning  as  a  glandular  proliferation  due  to  the  combination  of 
a  neural  cause  with  the  implanted  microbic  invasion,  whether  the  lat- 
ter be  a  common  infection  or  a  gonorrheal  infection  in  a  nulliparous 
uterus  or  similar  invasions  in  the  post-puerperal  condition,  the  tend- 
ency is  toward  an  extension  of  the  process  to  the  underlying  paren- 
chyma of  the  uterus,  resulting  in  an  abundant  formation  of  embryonal 
cells  in  this  situation  at  the  expense  of  the  muscular  and  connective 
tissues.  The  process  does  not  advance  along  the  ordinary  inflamma- 
tory stages  of  abscess-formation,  as  in  acute  inflammatory  affections, 
but,  doubtless,  owing  to  a  more  nearly  balanced  condition  of  warfare 
between  the  pathogenic  microbes  and  the  tissue-defenses,  remains  in 
the  stage  of  parenchymal  degeneration  and  proliferation  for  years 
unless  adequate  means  be  employed  for  its  correction. 

The  natural  history  of  the  affection  as  manifested  in  the  uterus 
is  therefore  divisible  into  three  stages,  more  or  less  distinctly  separable 
by  their  clinical  evidences,  the  first  stage  being  a  simple  endometritis 
with  leucorrhea,  but  without  interstitial  hypertrophy;  the  second  stage 
showing  both  leucorrhea  and  interstitial  hyperplasia,  the  latter  often 
presenting  the  physical  characters  of  the  "engorgement"  of  the  older 


88  DISEASES    OF    WOMEN. 

writers;  while  the  final  stage  is  one  of  hyperplasia  alone  without 
notable  morbid  discharges,  ending  in  sclerosis  and  final  atrophy  of 
the  muscular  structure. 

The  Therapeutic  Problem. — With  full  acquiescence  in  the  belief 
that  all  forms  of  chronic  metritis  are  essentially  bacterial  in  origin 
it  does  not  follow  that  a  microbicidal  course  of  treatment  is  the  only 
indication  to  be  followed,  notwithstanding  its  evident  importance  even 
in  the  latter  stages.  In  these  stages  of  the  process  a  more  important 
indication  lies  in  the  necessity  for  arousing  and  maintaining  more 
vigorous  trophic  processes  in  the  parts  so  long  overwhelmed  by  foreign 
forces,  for  it  should  be  understood  that  in  place  of  the  active  inflam- 
mation we  now  have  rather  the  debris  of  the  bacterio-phagocytic  con- 
test to  deal  with,  in  the  shape  of  interstitial  exudations  and  prolifer- 
ated connective  tissue.  The  therapeutic  problem  involves  a  correction 
of  these  conditions  and  consequences,  which,  in  the  cases  usually  seen 
by  the  specialist,  have  become  a  far  more  important  factor  in  the  dis- 
ease than  the  original  microbic  invasion. 

The  intra-uterine  therapeutics  of  the  day,  such  as  the  application 
of  caustics  and  the  curette  to  the  interior  of  the  uterus,  have,  doubt- 
less, accomplished  results  mainly  by  arousing  the  full  trophic  activi- 
ties of  the  part,  but,  as  stated  by  Apostoli  in  1887,^  "the  general 
reproach  which  may  be  made  against  all  intra-uterine  therapeutics 
adopted  so  far  might  be  summarily  formulated  as  follows: — 

"1.  It  is  brutal,  blind,  and  may  be  dangerous  in  inexperienced 
hands. 

"2.  Its  dosage  is  wanting. 

"3.  -ft  is  difficult  to  localize. 

"4.  It  has  a  more  or  less  instantaneous  action,  which  ceases  gener- 
ally after  its  application. 

"5.  It  is  sometimes  sterile,  inefficacious,  or  fanciful. 

"6.  It  treats  the  mucous  membrane,  but  is  wanting  in  direct 
action  upon  the  parenchyma." 

Induced  by  the  success  of  his  work  with  fibroid  tumors  of  the 
uterus,  Apostoli  began,  in  1883,  to  apply  a  similar  technique  to  the 


^  "On  a  New  Treatment  of  Chronic  Mei.ritis,"  bj'  Georges  Apostoli.    Trans- 
lated by  A.  Lapthorn  Smith,  Detroit,  1888. 


CATAKRHAL  AFFECTIONS  OF  UTERO-TUBAL  TRACT.        89 

affections  under  consideration,  'and  subsequently  affirmed  its  advan- 
tages in  the  treatise  mentioned  to  be^:— 

"1.  An  easy  method  which  any  gynecologist  can  execute  alone 
and  without  help. 

"2.  A  method  which  is  mathematically  dosable;  which  cauterizes 
much  or  little,  according  to  the  wish  of  the  operator;  and  which  is 
marvelously  subject  to  a  simple  and  precise  graduation. 

"3.  Progressive  cauterization,  which  is  never  instantaneous  and 
which  may  be  administered  in  fractional  doses,  the  effects  of  which 
accumulate  at  the  will  of  the  i^hysician. 

"4.  An  active  cauterization  which  may,  if  we  desire  it,  go  beyond 
the  limits  of  the  mucous  membrane  and  of  which  we  can  easily  grad- 
uate the  extent  and  depth. 

"5.  It  unites  the  galvano-ehemic  action  contemporary  with  the 
passage  of  the  current,  and  similar,  according  to  the  active  pole,  to 
that  of  acids  or  of  bases,  and  a  trophic  after-action  followed  by  a 
process  of  retrogression  and  certain  disintegration. 

"6.  A  rapid  method  which  offers  every  facility,  according  to  the 
intensity  of  cauterization,  to  act  with  variable  quickness  according  to 
the  case. 

"7.  Absolute  harmlessness  of  the  medication,  which  is  made  in 
an  aseptic  manner  and  without  harshness. 

"8.  Possibility  of  localization  in  a  case  where  we  do  not  wish  to 
effect  more  than  a  limited  extent  of  the  uterine  mucous  membrane. 

^'9.  A  weapon  with  a  double  edge,  which,  according  to  the  pole 
in  action,  is  able  to  give  either  an  hemostatic  effect  or  produce  conges- 
tion by  attraction  of  moisture. 

'"'lO.  A  cauterization  which  is  antiseptic  itself  on  account  of  the 
energy  of  the  released  ions  of  electrolysis. 

"11.  The  application  is  little,  or  not  at  all,  painful,  and  does  not 
require  anesthesia." 

The  general  directions  given  by  Apostoli  were  in  harmony  with 
the  known  actions  of  the  two  poles  of  a  galvanic  current, — namely, 
that  the  positive  pole  was  to  be  used  in  hemorrhagic  conditions  and 

^  Ibid.,  page  52. 


90  DISEASES    OF    WOMEN. 

where  a  microbicidal  effect  was  particularly  desired,  while  the  nega- 
tive was  reserved  for  hyperplasia  alone. 

A  personal  experience  that  has  been  by  no  means  small  has  con- 
vinced me  that  these  claims  of  Apostoli  have  been  fully  justified,  both 
from  the  point  of  view  which  requires  that  the  galvano-chemic  process 
be  used  as  a  controllable  means  for  the  destruction  of  the  morbid 
mucous  membrane,  and  from  that  in  which  reliance  is  placed  on  the 
arousing  of  trophic  activities  by  less  currents  applied  on  covered  elec- 
trodes. By  the  process  which  I  have  introduced  to  the  profession,  in 
which  mercuric  salts  may  be  cataphorically  applied  to  the  uterine 
surface  and  parenchyma,  I  have,  moreover,  made  it  possible  to  obtain 
even  quicker  results  in  resolution  of  the  morbid  process  and  absorp- 
tion of  the  redundant  cell-tissue  without  true  cauterization,  for  in  this 
process  the  cauterizing  oxygen  and  chlorine  are  absorbed  by  the  mer- 
cury. This  method  necessitates  the  use  of  the  positive  pole,  but  is 
specially  adapted  to  conditions  requiring  this  polarity,  and  its  employ- 
ment will  not  only  prove  to  be  superior  to  all  surface  medication  of 
the  endometrium,  but  render  curettage  unnecessary  except  when  bulky 
debris  exists  within  the  uterus. 

Diagnostic  Value  of  Inspection  of  Persistent  Uterine  Discharges. 
• — To  the  physician  not  engaged  in  the  major  surgery  of  gynecology 
only,  the  nature  and  characteristics  of  persistent  uterine  discharges  are 
a  matter  of  much  importance.  A  large  proportion  of  his  cases  are 
sure  to  be  some  form  of  utero-tubal  catarrh  which  is  invariably  at- 
tended in  some  stage,  and  particularly  in  its  more  curable  stage, 
by  an  abnormal  discharge  of  some  kind.  That  this  discharge  is  only 
second  to  pain  as  a  source  of  discomfort  to  the  patient,  and  is  a  direct 
issue  from  the  seat  of  the  disease,  are  facts  commanding  attention; 
and  our  interest  is  increased  when  we  recall  additionally  that  a  mere 
naked-eye  study  of  the  discharge  will  be  of  great  value  in  enabling 
us  to  decide  upon  the  propriety  and  exact  character  of  the  local 
treatment. 

This  subject  of  the  character  and  source  of  persistent  discharges 
formerly  received  much  attention  and  was  closely  allied  to  the  local 
treatment  of  those  days,  but  it  has  had  a  set-back  for  two  reasons, 
one  being  that  the  earlier  gynecologists  had  not  learned  to  add  to 
these  lessons  taught  by  visual  examination  of  the  secretions  the  in- 
valuable assistance  of  a  trained  bimanual  touch,  which  checks  off  and 
extends  the  information  thus  gained:  the  result  was  that  the  mind 


PLATE  X. 


Chronic  Leuconiiea  of  Vaginal  Origin. 


EURK  ft  MnirrsrarjC  CO  LTIH  ! 


PLATE  XI, 


Chrome  Purulent  Leucorhea  of  Uterine  Origin 


I  Mcnrrsrar.E  cq  lith  phil' 


PLATE  XII. 


Erosion  of  Cervix  with  slight  Laceration. 


3URK  3  A'j:/i'7?3J7u£  Ca.  UTli  h 


PLATE  XIII. 


.''  -K'-% 


Erosion  of  Cervix. 


BUR!:  a  uamanos  ca  imt  mi^ 


PLATE.XIV. 


Cervical  Endometritis  lEarly  Stage 


EiJKE.  a  MsrUlHlllClE  CQ  UTS  F 


PLATE  XV. 


Cervical  Endometritis  iLate  Staqe, 


simx  s  .v^niFuins  co  ins  fm.*- 


PLATE  XVI 


Ganorrheal  Endometritis  (Early  Stage. 


raar  a  usFrnsnns  co  irm.  mil' 


PLATE  XVII. 


Corporeal  Endometritis  of  septic  origin. 


EUKL  &  McmRIDCiE  CD.  LTtH  ! 


PLATE  XVIII, 


Purulent  Leucorrhea  m  Metro -Salpingitis  of  gonorrheal  origin. 


VRK  a  HsFTimnss  co.  nw.  fuji'- 


CATARRHAL  AFFECTIONS  OF  UTERO-TUBAL  TRACT.        91 

remained  closed  to  important  facts  of  upward  extension  of  the  condi- 
tions thus  revealed  by  discharges^  and  applications  were  made  to  the 
uterus  in  the  presence  of  salpingitis  and  ovaritis,  which  contra-indi- 
cated them. 

The  other  reason  for  the  recent  neglect  of  the  naked-eye  appear- 
ances of  uterine  discharges  as  a  means  of  diagnosis  and  an  indication 
for  treatment  is  the  therapeutic  nihilism  of  recent  leaders  in  gyne- 
cology, who  have  apparently  despaired  of  curing  any  form  of  metritis, 
and  busy  themselves  with  methods  for  amputation  of  the  organ.  This 
is  emjDhasized  by  the  dearth  of  exact  information  in  standard  treatises 
as  to  the  character  of  leucorrheal  discharges,  though  it  may  be  said 
that  the  work  of  Skene  is  a  distinct  exception  in  this  respect. 

As  stated  before,  all  catarrhal  conditions  of  the  utero-tubal  tract 
are  essentially  only  portions  of  the  same  disease,  yet  the  evidences  of 
a  predominant  seat  of  the  chronic  form  of  the  affection  in  one  or 
the  other  location  are  most  important  from  a  practical  point  of  view, 
for  their  proper  understanding  enables  us  to  apply  curative  agencies 
with  great  precision. 

In  Plates  X  to  XVIII  the  author  presents  the  first  illustrations 
that  have  been  published  of  the  several  varieties  of  cervical  and  cor- 
poreal discharges  of  persistent  character,  drawn  and  colored  directly 
from  nature.  For  this  unique  and  novel  series  we  are  indebted  to  a 
rare  combination  of  skill  and  patience  in  the  artist,  who  spared  no 
trouble  and  time  in  an  effort  to  accurately  portray  on  the  spot  the 
typical  cases  shown  him.^ 

Cervical  Endometritis. — In  a  state  of  health  there  are  no  appre- 
ciable discharges  from  either  the  uterus  or  vagina,  save,  of  course, 
the  menstrual  flow  and  a  slight  mucous  discharge  which  may  precede 
or  follow  it,  yet,  while  there  is  no  excretion,  there  is,  in  a  normal  con- 
dition, sufficient  secretion  from  the  mucous  membranes  of  these  parts 
for  the  maintenance  of  moist  conditions,  and,  doubtless,  for  bacteri- 
cidal purposes,  on  the  one  hand,  and  the  fostering  of  spermatic  life,  on 


'  The  coloring  of  these  drawings  is  vouched  for  as  a  correct  picture  of 
the  typical  cases  selected,  and,  as  some  of  the  cases  were  drawn  from  patients 
at  various  hospitals,  the  artist  was  enabled  to  obtain  a  technical  corrobora- 
tion of  the  coloring  from  the  physician  in  attendance  in  every  instance.  For 
clearness  of  illustration  it  was,  nevertheless,  necessary  to  represent  the  vagina 
as  shorter  than  natural. 


92  DISEASES    OF    -WOMEN. 

the  other.  The  normal  secretion  within  the  vagina  is  whitish,  acid 
in  reaction,  and  tends  to  collect  within  the  folds  and  about  the  cervix 
in  unmarried  women  as  a  white,  curdy  deposit  (Plate  X).  The  nor- 
mal secretion  within  the  cervical  canal  is  clear,  slightly  tenacious, 
and  alkaline  in  reaction.  In  a  condition  of  chronic  inflammation 
this  secretion  of  the  Xabothian  glands  of  the  cervix  becomes  more 
tenacious,  viscid,  and  opaque  (Plates  XIV  and  XV).  It  is,  at  times,  so 
tenacious  that  it  is  impossible  to  wipe  it  away  with  a  cotton  swab. 
When  the  stage  of  the  afl'ection  is  sfill  purulent  this  viscid,  stringy 
mucus  is  stained  by  admixture  with  pus-corpuscles,  and  its  reaction  is 
at  these  times  acid. 

This  form  of  cervical  catarrh  is  unquestionably  more  rare  than 
the  form  to  be  described  directly,  and  is  thought,  by  the  author,  to  be 
due  to  a  profound  microbic  invasion  of  the  Nabothian  glands  of  the 
cervix  from  gonorrheal  infection  of  long  standing. 

In  the  other  form  of  cervical  endometritis  the  most  prominent 
symptom  is  the  "granular  erosion,"  which  is  found  spreading  from  the 
external  os  over  a  varying  part  of  the  vaginal  portion  of  the  cervix 
in  an  area  concentric  with  the  opening  (Plates  XII  and  XIII).  This 
was  described  by  Bennett  and  the  older  gynecologists  as  "ulceration 
of  the  cervix."  .  The  true  nature  of  this  morbid  condition  has  been 
ascertained  by  Euge  and  Veit,  in  Germany,  and  de  Sinety,  in  France, 
to  be  a  morbid  proliferation  of  the  epithelium  surrounding  the  ex- 
ternal OS,  in  association  with  a  similar  condition  within  the  cervical 
canal.  It  is,  therefore,  usually  not  an  ulceration  at  all,  in  the  sense 
that  a  loss  of  substance  exists,  though  this  may  be  the  case,  but  in- 
volves the  singular  fact  that  the  cylindric  epithelium  of  the  cavity 
of  the  cervix  is  said  to  be  reproduced  outside  of  the  os  within  the 
eroded  area  where  pavement  epithelium  normally  exists.  Several  ex- 
planations of  this  odd  circumstance  are  given  by  recent  writers,  those 
of  the  surgical  school  holding  that  the  condition  is  frequently  pro- 
duced by  an  eversion  of  the  lining  of  the  canal  by  reason  of  laceration 
of  the  underlying  tissues  of  the  cervix  in  parous  women,  or  by  a  simple 
ectropion  of  the  membrane  by  reason  of  its  morbid  redundance  in 
nulliparas.  As  the  condition  is  most  frcijuently  met  with  in  women 
who  have  never  been  pregnant,  the  slight  bearing  of  laceration  on  its 
production  is,  nevertheless,  evident. 

It  appears  to  the  author  that  these  studies  do  but  little  to  clear 
up  the  practical  questions  at  issue,  and  that  Tyler  Smith's  claim  that 


CATARRHAL  AFFECTIONS  OF  UTERO-TUBAL  TRACT.        93 

the  conditions  observed  are  but  secondary  to  a  catarrhal  endometritis 
within  the  cavity  are  substantially  correct.  That  an  eroded,  or,  pos- 
sibly, hypertrophied  and  altered  epithelium  without  a  catai'rhal  cavity 
may  be  produced  by  an  acrid  discharge  from  within  it  is  well  proved 
by  the  condition  noted  on  the  skin  beneath  the  nostrils  in  neglected 
children  with  nasal  catarrh,  when  a  practically  similar  lesion  may  be 
seen.  In  some  of  these  cases  the  erosion  extends  to  the  vaginal  walls 
even,  making  the  resemblance  more  perfect.  If  the  two  conditions 
are  analogous  the  absurdity  of  treating  erosions  external  to  the  os  by 
direct  applications  to  this  surface  alone  is  evident. 

It  is  probable  that  this  peculiar  form  of  catarrhal  invasion  of  the 
cervical  cavity  is  due  to  a  special  form  of  pathogenic  microbe,  for  ob- 
servers have  noted  that  the  affection  may  involve  the  cavity  of  the 
corpus  as  well  as  the  cervix.  That  certain  individuals  are  prone  to 
contract  it  seems  also  established. 

When  the  Nabothian  glands  are  also  affected  there  is  a  tendency 
to  a  closure  of  their  ducts,  producing  shot-like  cysts  projecting  from 
the  surface,  which  may  lead,  by  pressure  atrophy,  to  extensive  cystic 
degeneration  of  the  cervix. 

The  constitutional  symptoms  of  cervical  endometritis  are  less 
marked  than  when  the  affection  is  generally  disseminated  through 
the  whole  organ,  yet  backache,  a  sense  of  weight  in  the  pelvis,  and 
often  menorrhalgia  accompany  the  leucorrhea. 

In  the  treatment  of  these  very  obstinate  affections  mere  applica- 
tions to  the  surface  will  be  ineffective  for  the  reason  already  given, 
that  the  disease  is  situated  deeply  in  the  cervical  mucous  membrane. 
The  most  effective  electric  method  is  the  use  of  mercuric  cataphore- 
sis,  for  here  we  have  a  penetrating  microbicide  and  alterative  that 
may  be  sent  to  any  depth  by  interstitial  diffusion.  The  zinc-mercuric 
method  is  probably  as  effective  as  the  gold-mercuric,  both  being 
applied  in  moderate  milliamperage  of  30  to  50  to  the  cervical  cavity. 
"When  associated  with  moderate  degrees  of  corporeal  endometritis,  as 
it  often  is,  it  is  generally  more  expedient  to  employ  the  mercury  on 
either  a  silver  or  copper  electrode,  owing  to  their  smaller  size  and  the 
possibility  of  properly  shaping  them  to  fit  the  cavity. 

Illustrative  Cases. — A  young  lady  of  22  who  had  been  suffering 
from  menorrhalgia  with  profuse  leucorrhea  for  three  years,  Avas  sent  to 
me  from  a  neighboring  city.  As  there  had  been  considerable  instru- 
mental treatment,  resulting  in  moderate  dilatation  of  the  introitus. 


94  DISEASES    OF    WOMEN. 

a  small  bivalve  speculum  was  inserted  (contrary  to  my  custom  in  vir- 
gins, as  erosion  is  easily  detected  by  touch  alone),  revealing  erosion 
of  the  OS  and  a  softened  and  dilated  cervix  as  far  as  the  internal  os. 
On  inserting  the  sound  the  internal  os  was  found  to  be  normally  tight 
and  the  cavity  of  normal  depth.  It  was  clear,  therefore,  that  the 
affection  was  confined  to  the  cervix  alone. 

As  this  case  and  the  following  one  were  seen  before  the  develop- 
ment of  mercuric  cataphoresis,  the  treatment  employed  was  positive 
galvano-chemic  cauterization  from  a  bare  platinum  electrode  inserted 
beyond  the  internal  os  and  slightly  withdrawn  before  turning  the  cur- 
rent on.  The  strength  employed  was  25  milliamperes  twice  a  week, 
followed  by  the  faradic  current.  At  the  end  of  six  weeks'  treatment, 
followed  by  two  weeks'  rest,  her  condition  was  materially  improved 
as  to  leucorrhea  and  the  general  symptoms,  but  the  erosion  remained 
little  changed.  The  applications  were  now  made  once  a  week  for  two 
months,  with  a  final  relief  from  all  symptoms  and  a  better  appearance 
in  the  eroded  area.  Just  what  the  condition  of  the  os  is  at  present, 
four  years  since  the  termination  of  the  treatment,  is  unknown,  but  the 
patient  remains  in  excellent  health. 

Mrs.  S.,  a  married  lady  of  25,  who  had  never  conceived,  presented 
symptoms  similar  to  the  last  patient  since  her  marriage,  a  period  of 
three  years.  After  much  ineffectual  treatment  she  applied  to  me  in 
March,  1891.    Her  condition  at  this  time  was  as  follows: — 

Her  principal  symptom  was  menorrhalgia,  associated  with  scant 
menstruation  and  intermenstrual  backache.  Examination  revealed 
erosion  extending  a  half-inch  in  all  directions  from  the  os,  with  copi- 
ous muco-purulent  catarrh  of  a  tenacious  character.  The  inner  os  was 
small  and  the  cavity,  as  a  whole,  measured  but  two  and  one-half  inches. 

In  spite  of  the  scanty  menstruation  it  was  thought  best  to  employ 
the  platinum  electrode  with  the  positive  galvanic  current,  beginning 
with  20  milliamperes.  The  applications  were  made  twice  a  week.  The 
following  period  was  free  from  pain  and  there  was  a  great  lessening 
of  the  discharge  without  any  improvement  in  the  appearance  of  the 
eroded  area.  After  two  months'  desultory  applications  treatment  was 
suspended  for  the  summer,  as  she  seemed  practically  well.  In  the  fall 
the  applications  were  renewed,  owing  to  one  period  having  been  pain- 
ful and  for  the  purpose  of  curing  the  erosion,  resulting  finally  in  a 
complete  restoration  to  health. 

Miss  E.,  a  maiden  lady  of  40,  had  been  in  poor  honlth  for  a  long 


CATARRHAL  AFFECTIONS  OF  UTERO-TUBAL  TRACT.        95 

time,  but  complained  principally  of  a  copious  purulent  leucorrhea 
and  pain  in  the  upper  spinal  region.  There  was  no  menorrhalgia. 
Examination  revealed  an  enlarged,  softened  cervix,  with  an  eroded 
surface,  which  I  was  able  to  show  to  the  artist  (Plate  XIII).  Like 
the  other  cases  mentioned,  there  were  distinct  evidences  of  non-in- 
volvement of  the  corpus. 

The  treatment  in  this  case  was  by  cupro-mercuric  cataphoresis, 
an  ordinary  nickel-plated  sound  being  denuded  of  its  plating  by 
dipping  it  in  acid,  after  which  it  was  amalgamated  by  redipping  in 
acid  and  then  in  mercury  and  rubbing  it  on  moistened  cotton.  The 
strength  of  the  current  was  35  to  40  milliamperes  for  ten  minutes, 
repeated  twice  a  week.  At  the  end  of  two  months  there  was  a  com- 
plete resolution  of  the  eroded  area  as  well  as  arrest  of  leucorrhea.  She 
received  appropriate  medication  for  her  general  health  at  the  same 
time. 

Corporeal  Endometritis. — Chronic  inflammation  of  the  cavity  of 
the  body  of  the  uterus  is  characterized  by  an  enlargement  of  this  por- 
tion of  the  organ  without  participation  of  the  cervix.  This  is  readily 
detected  by  a  comparison  of  the  conditions  found  by  simple  touch 
with  the  enlargement  detected  by  the  bimanual  touch,  and  particu- 
larly when  we  find  the  sound  will  go  to  a  depth  greater  than  the  normal 
two  and  a  half  inches  without  the  cervix's  participating  in  the  enlarge- 
ment. This  condition  is  by  no  means  rare,  for  it  is  liable  to  be  found 
in  all  cases  of  chronic  metritis  due  to  subinvolution  or  to  retention 
of  septic  material, — in  other  words,  whenever  the  condition  has  arisen 
independently  of  an  upward  extension  from  a  previously  inflamed 
cervix.  The  leueorrheal  discharge  in  these  cases  is  serous,  whether  it 
be  purulent  or  sanguineous,  and  is  therefore  readily  distinguished 
from  the  cervical  discharge,  though  not  so  readily  observed  in  the  act 
of  issuing  from  the  uterus.  The  therapeutic  management  of  chronic 
corporeal  endometritis  difi^ers  so  little  from  that  of  the  larger  number 
of  cases  of  general  chronic  metritis  that  further  consideration  of  the 
subject  is  incorporated  in  the  following  paragraphs. 

Chronic  Metritis. — The  clinical  experience  of  the  author  has  led 
him  to  the  conclusion  that  either  uterine  catarrh  or  its  consequences 
are  responsible  for  the  sufferings  of  a  large  proportion  of  the  patients, 
married  women  in  particular,  who  consult  physicians  for  symptoms  of 
obvious  pelvic  origin.  Reference  is  made,  of  course,  to  cases  of  a 
chronic  nature  which,  on  examination,  exhibit  an  enlargement  of  the 


96  DISEASES    OF    WOMEN. 

unimpregnated  uterus  above  the  size  natural  to  the  state  of  life  of  the 
patient.  Though  such  a  condition  may  date  from  a  puerperal  sub- 
involution and  the  leucorrheal  stage  be  long  past,  its  dependence  on 
an  original  bacterial  invasion  is  none  the  less  definite,  for  in  an  organ 
of  this  particular  structure  the  active  stage  of  inflammation  repre- 
sented by  the  bacterio-phagocytic  contest  occupies  but  a  small  part 
chronologically  of  the  so-called  inflammatory  process,  the  tissue  re- 
action evidenced  in  a  proliferation  of  the  connective-tissue  cells 
becoming  a  far  more  persistent  feature.  The  stubbornness  of  an 
analogous  inflammation  of  the  nasal  mucous  membrane  is  quite 
familiar.  The  persistence  of  a  catarrh  of  the  uterine  mucous  mem- 
brane is  even  more  likely,  for  the  membrane  in  this  case  overlays  a 
tissue  more  open  to  invasion,  and  subject  to  the  periodic  congestions 
of  menstruation  and  pregnancy. 

Clear  views  of  this  nature  are  exceedingly  important  from  a  thera- 
peutic point  of  view,  and  will  displace  from  serious  consideration 
many  minor  mechanical  faults  of  the  uterus  to  which  too  much  atten- 
tion has  been  paid  of  late.  Versions,  flexions,  and  even  moderate 
lacerations  of  the  cervix  become  of  secondary  importance  in  a  still 
movable  uterus  which  is  the  seat  of  this  trophic  disorder.  The  ver- 
sions and  flexions  are,  in  fact,  often  due  to  the  interstitial  changes 
within  the  uterine  wall,  either  from  overweight  or  unequal  distribu- 
tion of  the  morbid  process  to  one  aspect  or  the  other  of  the  muscular 
fibres,  while  the  healed  laceration  which,  when  it  occurred,  had  opened 
the  avenue  of  infection,  will  present  no  symptoms  after  the  dissipa- 
tion of  the  inflammatory  process.  To  cut  out  such  healed  scar-tissue 
at  this  stage  is  like  locking  the  stable-door  after  the  horses  are  stolen. 

Such  a  purely  mechanical  theory  of  uterine  affections  arose  in 
the  prebacterial  age  of  medicine,  and  should  be  dispassionately  re- 
viewed in  the  light  of  this  important  addition  to  human  knowledge. 

The  direct  cause  of  all  cases  of  chronic  metritis  is,  of  course,  a 
microbic  invasion  made  possible  by  a  lessened  physiologic  resistance 
or  a  traumatism.  The  special  microbe  involved  may  be  either  the 
gonococcus,  in  which  case  an  acute  stage  must  precede  the  one  under 
consideration,  or  more  ordinary  pathogenic  varieties  which  are  always 
present  in  the  vagina  and  cervix,  but  never  normally  above  the  internal 
OS.  It  would  seem  that  the  inner  end  of  the  cervical  canal  was,  under 
ordinary  circumstances,  an  inner  line  of  defence  against  such  inva- 
sions by  virtue  of  its  secretions,  and  that  no  pathogenic  organisms 


CATARRHAL  AFFECTIONS  OF  UTERO-TUBAL  TRACT.        97 

succeed  in  passing  this  point  unless  the  defenses  of  the  body  are 
lowered  by  neural  conditions  or  by  traumatism, 

A  cumulative  increase  in  a  cervical  endometritis,  coupled  with 
increased  susceptibility,  accounts  for  the  upward  invasion  without 
traumatism. 

Traumatism,  as  a  cause  of  corporeal  endometritis,  which  is  but 
the  earlier  stage  of  parenchymatous  metritis,  includes  the  cases  due 
to  subinvolution,  to  the  retention  of  septic  remnants  of  fetal  mem- 
branes after  instrumental  delivery  or  abortion,  to  laceration  of  the 
cervix,  and  to  the  harsh  use  of  instruments. 

The  term  chronic  metritis  includes,  therefore,  a  variety  of  con- 
ditions with  widely  differing  clinical  characters,  depending  on  the 
nature  of  the  tissues  mainly  attacked,  as  well  as  the  stage  of  the  affec- 
tion and  the  character  of  the  microbic  cause. 

From  certain  clinical  points  of  view  these  cases  of  chronic  metritis 
are  divisible  into  two  other  classes  that  much  resemble  the  divisions 
made  by  the  late  George  M.  Beard  in  cases  of  sexual  disease  in  the 
male.  In  the  one  class  the  affection  occurs  as  a  purely  local  disease, 
the  nervous  organization  of  the  individual  being  so  robust  that  it  fails 
to  be  affected  by  the  local  disturbance;  in  the  other  class  a  far  less 
degree  of  local  trouble  may  be  found,  associated  with  profound  depres- 
sion and  disorder  of  the  nervous  system, — a  disorder  that,  at  times, 
seems  greatly  disproportioned  to  the  local  disease.  On  these  reflex 
symptoms  some  doubt  has  been  thrown  of  late,  but  the  best  proof  that 
pains  in  the  anterior  crural  region  and  in  the  back,  with  or  without 
nervous  prostration,  are  caused  by  this  "irritable"  uterus  is  given  by 
the  disappearance  of  such  symptoms  in  a  sufficiently  large  number  of 
cases  as  a  result  of  local  treatment.  The  reason  of  the  doubt  may 
possibly  have  been  a  lack  of  neurologic  training  in  certain  gynecolo- 
gists, who  have  mistakenly  treated  such  diseases  as  hysteria,  neural- 
gia, locomotor  ataxia,  and  even  scoliosis,  in  the  writer's  experience,  as 
mere  nervous  manifestations  of  pelvic  disease.  The  prevalence  and 
ultimate  discredit  of  the  recent  fad  in  which  it  was  attempted  to  cure 
not  only  uterine  inflammation,  but  many  nervous  diseases,  by  remov- 
ing scar-tissue  from  the  cervix,  may  also  be  partly  responsible  for  this 
attitude. 

In  the  first  class  of  cases  mentioned  the  treatment  may  be  carried 
out  in  the  office,  but  cases  accompanied  by  nervous  prostration  are 

7 


98  DISEASES    OF    WOMEN. 

suited  only  to  the  salutary  care  of  an  institution  in  which  both  the 
local  and  nervous  elements  in  the  case  will  receive  due  recognition. 

Intra-uterine  treatment  is  essential  in  these  cases  and  is  only  sub- 
ject to  the  ordinary  rules  of  gentleness  and  frequency,  since  it  is 
assumed  that  no  instances  of  extension  of  the  disease  to  the  appen- 
dages are  now  under  consideration.  The  galvanic  anode  has  generally 
seemed  best  in  my  practice  whenever  catarrhal  symptoms  are  para- 
mount, and  it  is  usually  followed  by  either  a  primary  or  secondary 
monopolar  faradic  current  before  the  instrument  is  withdrawn.  The 
character  of  the  intra-uterine  electrode  is  also  important,  the  covered 
elastic  instrument  being  usually  preferable  and  easily  inserted  on 
account  of  the  patulous  condition  of  the  os,  unless,  indeed,  it  be 
thought  best  to  employ  mercurialized  electrodes  on  account  of  a  pro- 
nounced abnormality  of  the  mucosa  still  present.  Between  the  inter- 
vals of  the  intra-uterine  treatment  daily  vaginal  applications  should 
be  made. 

The  effect  of  these  relatively  strong  intra-uterine  applications 
upon  fertility  deserves  consideration.  In  a  series  of  thirty-two  cases 
reported  in  a  paper  before  the  American  Electro-Therapeutic  Associa- 
tion, in  1894,^  I  was  able  to  ascertain  that  six  cases  had  become  preg- 
nant since  the  termination  of  the  treatment.  At  the  same  meeting 
Apostoli  contributed  a  paper  also,  in  which  he  reported  eighty  cases 
that  had  become  pregnant  after  electric  treatment.  The  proportions 
reported  by  me  are,  of  course,  not  matters  of  definite  ascertainment 
since  a  considerable  number  of  the  cases  treated  were  not  married, 
and  may  instances  of  pregnancy  have,  doubtless,  occurred  among  the 
cases  treated  without  the  knowledge  of  either  observer.  Considering, 
however,  that  the  greater  number  of  all  these  were  unquestionably 
sterile  at  the  beginning  of  treatment,  on  account  of  the  morbid  con- 
dition of  the  m.ucous  membrane  and  its  discharges,  it  would  seem  that 
the  effect  is  to  increase  the  fertility. 

Post-puerperal  Metritis ;  Neglected  Subinvolution. — Arrested  in- 
volution of  the  post-parturient  uterus,  whether  due  to  inertia,  non- 
traumatic infection,  or  traumatic  infection,  is  more  successfully  and 
quickly  treated  by  electricity  than  by  any  otlier  means  at  our  disposal. 
It  is  even  a  question  whether  normal  involution  would  not  be  materi- 


'  See  Appendix  B. 


CATARRHAL  AFFECTIONS  OF  UTEEO-TUBAL  TRACT.        99 

ally  hastened  by  the  systematic  application  of  faradic  currents  to  the 
highly  contractile  tissue  still  constituting  the  bulk  of  the  uterus,  as 
advised  by  Apostoli.  Certain  it  is  that  when  the  natural  process  is 
sluggish  by  reason  of  a  diminished  rate  of  shrinkage  in  the  muscular 
fibres  a  few  applications  of  the  faradic  current  from  the  primary  or 
a  coarse  wire  secondary  coil  will  stimulate  the  flagging  muscular  tissue 
to  develop  its  normal  tone.  Sanguineous  discharges  continuing  be- 
yond the  normal  periods  of  their  appearance,  or  recurring  during  the 
first  month  after  parturition,  may  be  controlled  by  one  or  two  such 
applications;  and  if  there  is  no  sepsis  or  traumatism  as  a  causative 
factor,  no  other  treatment  is  necessary.  Either  the  monopolar  or  the 
bipolar  method  may  be  employed,  but  the  primary  current  is  always 
preferable. 

But  it  is  rare  for  subinvolution  to  be  of  so  simple  a  nature, — 
shreds  of  retained  decidua,  a  morbid  condition  of  the  endometrium, 
a  laceration  or  other  trauma,  being  the  determining  causes  of  a  septic 
endometritis  to  which  the  subinvolution  is  due.  In  these  cases  the 
galvanic  current  is  indicated  with  the  simple  positive  pole  or  with 
zinc-mercuric  cataphoresis  if  the  hemorrhagic  feature  predominates, 
though  in  simple  cases  the  covered  elastic  electrode  is  best  on  account 
of  giving  the  least  pain.  The  swelling  method  (gradually  increased 
and  diminished  currents)  should  be  employed,  with  a  dosage  varying 
from  25  to  60,  or  more,  milliamperes.  To  this  the  faradic  current 
may  also  be  added. 

For  a  septic  condition  of  the  uterus  the  positive  mercuric  pole  is 
the  most  satisfactory,  owing  to  its  distinct  bactericidal  powers,  and,  if 
the  foul  discharge  comes  from  only  small  shreds  of  retained  membrane 
or  clots,  it  is  quite  unnecessary  to  resort  to  the  risks  and  loss  of  blood 
attending  the  use  of  the  curette.  The  drainage  that  follows  a  galvanic 
application  will  usually  be  amply  sufhcient  to  carry  off  these  shreds 
when  detached  by  the  action  set  up  by  the  current;  but  if  the  placental 
remnants  be  large  and  abundant  the  dull  curette  should  be  used  before 
the  alterative  and  contracting  applications  are  made.  In  the  author's 
opinion  the  sharp  curette  should  be  abandoned  altogether,  as  its  indi- 
cations are  better  met  in  every  case  by  the  galvanic  current  alone. 

Hemorrhagic  Metritis. — This  condition  is  either  due  to  the  reten- 
tion of  shreds  in  neglected  subinvolution  or  to  a  vegetative  hyper- 
trophy of  the  mucous  membrane  of  the  body  (adenomatous  endome- 
tritis), or  finally  to  hemophilia.     Its  treatment,  except  when  due  to 


100  DISEASES    OF    WOMEN. 

the  last-named  condition,  yields  the  most  accurate  and  successful  re- 
sults in  the  whole  range  of  electro-therapeutics.  The  writer  has  never 
had  a  case  fail  to  respond  promptly  to  the  proper  use  of  the  positive 
pole  of  the  galvanic  current,  after  the  method  popularized  by  Apostoli, 
in  which  sectional  electrodes  are  used  for  the  purpose  of  cauterizing 
the  entire  mucous  membrane  of  the  cavity,  step  by  step.  Since  the 
adoption  of  a  mercury-coated  zinc  electrode,  however,  he  is  convinced 
that  time  may  be  gained  by  its  use  in  place  of  the  carbon  instrument. 
The  first  applications  with  any  kind  of  electrode  are,  nevertheless, 
likely  to  induce  bleeding,  which  lessens  in  amount  with  each  subse- 
quent application.  The  instrument  should  always  be  bare,  and  the 
current-strength  may  vary  from  50  to  100  milliamperes  according  to 
the  obstinacy  of  the  case. 

Hyperplasia  of  the  Uterus,  with  or  without  Cervical  Laceration. 
— It  is  by  no  means  rare  for  the  clinician  to  encounter  cases,  which, 
presenting  the  nervous  symptoms  of  chronic  metritis  related  above, 
reveal,  on  examination,  an  enlarged  uterus  without  notable  discharge 
from  the  cavity.  The  uterus,  as  a  whole,  may  be  enlarged,  but  the 
hypertrophy  is  generally  limited  to  the  corpus  alone,  which  is  indu- 
rated, usually  retroposed  or  retroflexed,  and  only  moderately  fixed  if 
the  appendages  are  healthy. 

Such  cases  are  instances  of  the  later  stages  of  chronic  metritis, 
and  will  usually  give  a  history  of  more  or  less  discharge  at  an  earlier 
period.  The  cervix,  in  many  such  cases,  will  show  a  healed  laceration, 
showing  clearly  the  avenue  by  which  the  infection  originally  entered. 

It  is  in  this  class  of  cases  that  Emmett's  operation  of  trachelor- 
rhaphy has  been  most  frequently  performed,  and  some  of  my  cases  were 
instances  in  which  the  operation  had  already  been  done,  without  relief 
of  the  symptoms  or  material  lessening  of  the  abnormal  bulk  of  the 
organ.  It  is,  of  course,  conceivable  that  this  operation  may  result  in 
a  lessened  bulk  of  the  uterus  by  its  derivative  and  revulsive  effects, 
though  erroneously  performed  in  a  belief  that  the  healed  tear  was  a 
source  of  the  symptoms;  but  this  is  rare  excepting. when  the  cervix 
participates  in  the  hypertrophy. 

The  true  lesion  in  these  cases  is  unquestionably  a  degeneration 
of  the  muscular  substance  of  the  uterus  and  its  replacement  by  embry- 
onic tissue  of  sluggish  vitality.  The  ideal  treatment  is,  therefore,  one 
which  will  stimulate  metabolic  activities,  promote  absorption,  and 
favor  regeneration  of  the  muscular  fil)rils.     Nothing  can  equal  the 


CATARKIIAL    AFFECTIONS    OF    UTEKO-TUJJAL    TKACT.  101 

negative  pole  of  the  galvanic  current  for  these  purposes,  assisted  by 
concurrent  applications  of  the  contracting  faradic  current  (from  either 
the  primary  or  a  coarse-wire,  secondary  coil).  The  galvanic  current  is, 
by  far,  the  most  important  portion  of  the  electric  treatment,  and 
should  be  applied  in  appropriate  dose  either  twice  or  thrice  weekly. 

Illusiraiive  Cases. — Mrs.  M.,  aged  31,  an  excellent  instance  of 
the  class  mentioned  in  which  the  general  nervous  system  had  resisted 
the  effects  of  pelvic  disease,  was  admitted  to  the  sanatorium  from  a 
neighboring  city  January  28,  1892.  The  uterine  trouble  from  which 
she  suffered  dated  from  her  first  confinement  seven  years  before,  and 
was  aggravated  by  each  of  two  subsequent  confinements,  the  last  hav- 
ing been  eighteen  months  before.  She  complained  of  sacral  aching 
and  a  dragging  sensation  in  the  pelvis  which  was  aggravated  by  the 
erect  posture  and  by  walking,  rendering  her  particularly  miserable  in 
the  evening.  Menstruation  was  regular,  but  scanty,  and  the  alimen- 
tary functions  were  normal.  There  had  been  a  history  of  considerable 
leucorrhea,  but  none  was  now  complained  of. 

Examination  showed  an  enlarged,  retroverted  uterus  with  an 
eroded  os  and  a  cavity  four  inches  in  depth,  exuding  inspissated  mucus. 
A  spot  in  the  rear  of  the  uterus  was  extremely  tender.  She  had  been 
wearing  a  Smith-Hodge  pessary,  which  was  removed.  Treatment  was 
begun  by  vaginal  alternatives  of  the  galvanic  current  and  the  second- 
ary faradic,  but  it  was  quickly  changed  to  covered  negative  intra- 
uterine applications  of  30  milliamperes  in  view  of  the  absence  of  dis- 
ease of  the  appendages,  alternating  with  the  vaginal  applications.  In 
five  days  there  was  a  decided  relief  of  soreness;  but  it  was  necessary  to 
continue  treatment  six  weeks  in  the  house,  followed  by  several  months' 
office  treatment  at  intervals  before  complete  symptomatic  cure.  At 
this  time  the  uterus  was  normal  in  size  and  depth  and  but  slightly 
retroposed.  The  completeness  of  the  cure  has  been  tested  by  five  years' 
observation  and  one  pregnancy  without  relapse. 

Mrs.  P.,  aged  33,  was  sent  to  me  by  Dr.  Oaks,  of  North  Ridge- 
ville,  Ohio.  This  case  was  a  good  example  of  the  second  class  of  cases 
mentioned,  where  uterine  disease  reacted  unfavorably  on  the  nervous 
system  in  connection  Avith  other  depressing  agencies.  She  had  been 
married  but  four  years;  but  had  been  in  bad  health  since  four  years 
before  marriage,  which  had  been  sterile.  The  beginning  of  the  trouble 
was  clearly  in  a  virginal  endometritis  with  menorrhalgia  dating  from 
puberty,  and  the  gradually-increasing  uterine  involvement  had  been 


102  DISEASES    OF    WOMEN. 

assisted  by  a  neuropathic  heredity  and  the  strain  of  nursing  a  sick 
mother.  Tlie  pain  continued  very  severe  at  the  periods,  with  scanty 
flow,  and  there  was  vaginismus  and  dyspareunia.  She  complained  of  a 
neuralgic  pain  "all  over  the  body"  that  was  most  distressing  at  night. 
Examination  showed  the  uterus  enlarged,  retroflexed,  adherent,  and 
very  tender.  The  cavity  was  three  and  one-half  inches  deep  and 
exuded  considerable  muco-pus.  The  patient  was  placed  on  a  six  weeks' 
course  of  intra-uterine  negative  galvanic  applications  of  20  to  30 
milliamperes  and  the  rest  cure  with  general  galvanic  stimulation,  and 
very  shortly  showed  an  improvement  in  both  local  and  general  symp- 
toms, followed  by  an  ultimate  restoration  of  health. 

Mrs.  C,  aged  26,  applied  for  treatment  at  the  Howard  Hospital, 
complaining  of  weak  back  and  pain  in  the  pelvis.  She  had  never  been 
pregnant,  and  the  leucorrhea,  which  had  lasted  for  four  years,  was 
clearly  traceable  to  one  or  more  attacks  of  gonorrhea.  The  uterus  was 
but  slightly  above  the  normal  size,  yet  tender  and  exuding  abundant 
muco-pus.  She  was  placed  on  positive  intra-uterine  applications 
of  20  milliamperes  once  a  week  and  negative  vaginal  applications 
twice  a  week,  December  12,  1890.  Pain  was  shortly  relieved,  and  by 
the  following  month  the  leucorrhea  had  been  controlled. 

For  the  table  of  the  ultimate  results  in  thirty-two  cases  see  Ap- 
pendix B. 

Senile  or  Atrophic  Metritis. — The  importance  of  this  form  of 
metritis  has  been  particularly  shown  by  Skene. ^  It  may  be  resultant 
either  from  a  purulent  endometritis  of  earlier  years  that  has  been 
neglected  or  it  may  be  developed  after  the  menopause.  By  reason 
of  the  lowered  vitality  of  the  senile  sexual  organs  this  affection  is 
unusually  intractable  to  ordinary  methods  of  treatment,  the  ulcera- 
tion of  the  mucous  membrane  resulting  in  its  ultimate  destruction 
and  of  the  tissues  beneath  it  also  at  times.  The  resemblance  to  car- 
cinoma is  very  great  in  the  later  stages  of  erosion,  from  Avhich  it  can 
be  clinically  distinguished  by  the  leucorrhea  being  muco-purulent  or 
merely  purulent  instead  of  serous,  as  in  cancer. 

Goelet  has  recommended  the  negative  pole  of  the  galvanic  cur- 
rent, but  my  own  experience  indicates  that  zinc-mercury  cataphoresis 
is  far  superior  owing  to  its  non-cauterant  action  and  the  specially  help- 
ful effects  derivable  from  the  nascent  chemicals  released.    A  less  cur- 


'Medical  Gynecology,"  page  489. 


CATARRHAL   AFFECTIONS    OF    UTERO-TUBAL    TRACT.  103 

rent-strength  is,  moreover,  sufficient  in  the  latter  case,  being  propor- 
tional, however,  to  the  extent  and  stage  of  the  disease.  Twenty  to 
50  milliamperes  applied  to  the  whole  of  the  affected  surface  twice  or 
thrice  weekly  quickly  removes  all  odor  and  will  result  in  a  complete 
cure  in  several  months. 

Metrosalpingitis. — Though  it  is  rare  for  the  physician  to  encoun- 
ter an  endometritis  or  metritis  in  an  acutely  active  stage  (unless  due  to 
gonorrhea  or  bad  surgery),  it  is  not  unusual  to  be  called  in  a  case  of 
acute  or  subacute  salpingitis,  either  original  or  recurrent,  and  in  such 
a  case  the  judicious  use  of  vaginal  applications  of  the  bipolar  faradic 
current  at  the  bedside  will  not  only  replace  opium  and  other  sedatives 
largely,  but  materially  reduce  the  extent  and  duration  of  the  inflam- 
mation. Care  should  be  observed  not  to  cause  pain  either  by  the  in- 
sertion of  the  electrode  or  by  the  current,  which  should  invariably  be 
from  a  long,  fine,  secondary  wire  and  controlled  carefully.  The  bipolar 
electrode  should,  of  course,  be  warmed  before  insertion,  as  pointed  out 
by  Goelet,  the  patient  lying  at  ease  in  bed  and  well  covered,  and  the 
application  should  be  prolonged  for  fifteen  or  twenty  minutes.  If 
distinct  relief  is  experienced  (and  generally  there  is  a  pronounced 
relief  of  pain)  the  application  may  be  repeated  twice  a  day. 

Among  the  conditions  closely  allied  to  chronic  catarrhal  metro- 
salpingitis and  salpingo-oophoritis  are  interstitial  or  parenchymatous 
salpingitis,  purulent  salpingitis,  pyosalpinx,  hydrosalpinx,  hemato- 
salpinx, and  simple  ovaritis,  with  or  without  prolapse  of  the  organs. 
Each  of  these  conditions  is,  of  course,  readily  diagnosed  during  or  after 
an  abdominal  section,  but,  as  the  desire  of  the  conservative  gynecolo- 
gist is  the  cure  of  the  patient  without  a  cutting  operation,  he  is  re- 
stricted almost  entirely  to  the  very  probable  diagnoses  made  by  an 
educated  bimanual  touch  in  connection  with  the  subjective  and  other 
available  objective  symptoms;  and  when  we  reflect  upon  the  high 
training  that  may  be  attained  by  the  skilled  finger  in  detecting  the 
grosser  differences  between  these  several  conditions,  and  the  fact  also 
that  they  are  all  merely  different  stages  and  differently  situated  evi- 
dences of  the  same  disease, — inflammation, — it  would  seem  that  such 
diagnoses  were  amply  sufficient  for  this  class  of  work.  If,  for  instance, 
the  doubt  lay  between  a  simple  salpingitis  or  an  ovaritis,  and  the  case 
could  be  cured  by  vaginal  applications  of  electricity  without  resolving 
the  doubt,  the  patient  would  surely  prefer  us  to  leave  the  matter  un- 
certain rather  than  have  a  dangerous  exploratory  laparotomy  for  the 


104  DISEASES    OF    WOMEN. 

satisfaction  of  curiosity,  even  though  the  curiosity  be  thoroughly 
scientific. 

In  their  j)ronounced  stages  these  several  conditions  are  quite 
amenable  to  reasonably  correct  diagnosis  by  touch,  pointing  to  certain 
variations  in  the  electric  treatment. 

In  subacute  or  chronic  metrosalpingitis,  evidenced  by  pain  be- 
tween the  periods,  tenderness  in  one  or  both  vaginal  fornices,  and  by 
a  more  or  less  clearly  defined  enlargement  of  the  tube  or  by  mere 
bogginess  in  its  region,  the  treatment  must  at  first  be  altogether 
vaginal,  both  galvanic  and  faradic,  though  a  moderate  galvanic  cur- 
rent may  be  quickly  attained.  The  results  in  lessened  pain  and  shrink- 
age of  the  hypertrophied  tissue  are  soon  attested,  for  the  parts  are 
membranous  and  easily  reached  by  a  sufficient  density  of  current,  even 
though  indirectly  applied.  That  drainage  through  the  uterus  may  be 
promoted,  particularly  by  the  negative  pole  in  the  vagina,  is  unques- 
tionable. 

This  treatment  alone  can  be  relied  on  to  secure  a  practical  cure 
in  a  considerable  proportion  of  the  cases,  but  the  majority  will  demon- 
strate that  vaginal  applications  of  electricity  alone  will  be  insufficient, 
for  the  probable  reason  that  much  of  the  original  mischief  remains  in 
the  uterus.  ^\^en,  therefore,  a  considerable  amelioration  of  the  symp- 
toms has  been  gained  by  the  vaginal  treatment,  but  the  progress  thus 
far  made  does  not  continue,  the  uterus  being  reasonably  movable, 
though  with  pain,  and  manifestly  enlarged,  we  should  resort  to  tenta- 
tive intra-uterine  applications  without  further  delay. 

The  intra-uterine  treatment  should,  nevertheless,  be  carefully 
watched,  since  acute  salpingitis  or  ovaritis  or  an  encysted  purulent 
inflammation  of  either  organ  will  be  made  worse  by  this  form  of  treat- 
ment. Increased  pain  or  a  recrudescence  of  inflammation  in  a  pyo- 
genic cavity  will  often,  indeed,  attend  the  mere  passage  of  a  sound; 
but,  as  recently  pointed  out  by  Apostoli,  an  intolerance  of  intra-uterine 
galvanic  applications  points  so  unerringly  to  encysted  pus  as  to  become 
a  means  of  establishing  an  exact  diagnosis.  I  am  myself  convinced 
that  we  may  trench  closely  upon  this  debatable  ground  with  every 
advantage  to  the  patient  if  precautions  be  observed  to  eliminate  all 
harshness  of  manipulation  from  the  method.  If,  for  instance,  a 
covered  spiral  electrode  only  be  used,  inserted  by  touch  only  without 
the  speculum  and  without  drawing  upon  the  uterus  or  otherwise  dis- 
turbing its  relations  to  the  surrounding  tender  parts,  we  may  test  the 


CATARRHAL    AFFECTIONS    OF    UTERO-TUBAL    TRACT.  105 

intolerance  of  the  case  to  electricity  itself,  which  is  quite  another 
matter  from  its  tolerance  to  a  more  or  less  brutal  handling  plus 
the  electricity.  The  spiral  electrode  will  adapt  itself  readily  and  pain- 
lessly to  any-shaped  cavity,  and,  when  employed  as  a  positive  pole, 
which  is  preferable,  will  not  only  inaugurate  a  wholesale  change  in 
the  activity  of  tissue-metamorphosis  within  the  affected  structures  of 
the  uterus,  but  ultimately  promote  drainage  from  the  uterine  end  of 
the  tube.  Less  pain  is  produced  also  if  the  electrode  be  only  partly 
inserted  during  the  first  applications. 

Twenty  milliamperes  is  ample  for  a  beginning  in  these  tentative 
applications,  repeated  every  fourth  or  fifth  day,  though  the  daily 
vagino-abdominal  treatment  should  be  continued  as  usual.  The  fol- 
lowing cases  may  be  cited  as  examples  in  which  the  uterine  seat  of  the 
affection  was  still  mainly  predominant: — 

Illustrative  Cases. — Mrs.  "W.  F.  D.,  aged  27,  entered  the  sanato- 
rium from  a  town  in  the  interior  of  Pennsylvania  with  a  history  of 
continuous  suffering  since  the  birth  of  an  only  child,  eight  years 
before.  Instruments  had  been  used  at  her  confinement  and  she  was 
in  bed  three  months  afterward.  There  was  a  continuous  sensation  of 
weight  in  the  pelvis,  a  band  sensation  about  the  waist,  and  constant 
pain  in  the  bladder  and  ovarian  region.  Examination  showed  the 
uterus  posterior-placed,  enlarged,  and  brawny,  with  a  tender  mass  in 
the  region  of  the  left  tube  and  ovary.  She  had  painful  periods  and 
a  constant,  copious  leucorrhea.  For  two  weeks  the  patient  was  placed 
on  vagino-abdominal  galvanic  and  faradic  treatment  and  general 
electric  stimulation,  with  but  moderate  results.  I  then  determined  to 
test  the  effect  of  intra-uterine  galvanic  treatment,  30  milliamperes, 
positive,  being  used  with  the  elastic  electrode.  Considerable  pain 
resulted  from  the  first  application,  but  before  the  next  day  the  band 
sensation  had  disappeared,  and  never  returned.  The  intra-uterine 
treatment  was  continued  twice  a  week  for  six  weeks,  when  she  re- 
turned home  practically  well.  Four  years  later  the  permanence  of  the 
cure  was  attested  by  every  evidence  of  blooming  health. 

Miss  P.,  aged  24,  was  suffering  from  a  catarrhal  and  congestive 
condition  of  the  uterus  and  left  tube  and  ovarj'-,  traceable  to  a  fall 
from  a  hammock  sixteen  months  previously,  which  had  been  ineffect- 
ually treated  by  the  ordinary  methods.  The  most  striking  symptoms 
on  admission  were  weakness  in  the  back,  inability  to  walk  far,  a  sensa- 
tion described  as  a  burning  or  itching  in  the  ovarian  regions,  and  a 


106  DISEASES    OF    WOMEN. 

considerable  leucorrhea.  Examination  showed  the  uterus  enlarged 
and  giving  exit  to  a  muco-purulent  discharge  and  the  left  tube  very 
tender.  She  was  placed  on  positive  intra-uterine  galvanic  applications 
of  20  to  25  milliamperes  to  the  cavity  twice  a  week,  and  both  currents, 
vagino-abdominal,  at  frequent  intervals  for  six  weeks,  followed  by 
occasional  intra-uterine  applications  for  three  months  longer,  result- 
ing in  relief  of  all  symptoms  and  a  restoration  to  health  which,  at 
this  writing,  five  years  later,  remains  perfect. 

Mrs.  W.,  aged  35,  applied  at  the  Howard  Hospital  October  22, 
1895,  complaining  of  pain  in  the  back  and  lower  portion  of  the  abdo- 
men and  a  peculiar  sensation  in  the  top  of  the  head,  which  dated  from 
two  miscarriages  and  a  probable  specific  infection  twelve  years  before. 
She  had  been  sterile  since  the  gonorrheal  aftack.  Menstruation  had 
been  scanty  of  late.  The  condition  of  the  cervix  and  its  discharges 
are  shown  in  Plate  XVIII,  having  been  drawn  at  the  time  by  the 
artist.  The  bimanual  examination  revealed  posterior  fixation  and 
moderate  enlargement  of  the  uterus  with  indefinable  bogginess  in  the 
left  tubal  region.  Just  before  seeing  me  a  colleague  in  the  hospital 
had  given  the  opinion  that  a  removal  of  the  tubes  and  ovaries  was 
essential  to  saving  her  life.  She  was  placed  on  negative  vagino- 
abdominal applications  of  50  milliamperes  for  three  months,  during 
which  time  there  appeared  great  improvement  in  the  symptoms.  The 
treatment  was  now  changed  to  cupro-mercuric  applications  within  the 
uterus  of  20  and  30  milliamperes  once  a  week  for  three  months.  The 
symptomatic  cure  was  perfect  at  the  end  of  six  months,  the  patient 
declaring  herself  well. 

Purulent  Salpingitis. — A  neglected  catarrhal  metrosalpingitis, 
particularly  of  gonorrheal  origin,  readily  becomes  muco-purulent,  re- 
sulting in  a  more  protracted  electric  treatment  before  a  cure  can  be 
attained  by  the  methods  already  described.  If  of  long  standing,  and 
drainage  through  the  uterine  mouth  of  the  tube  has  been  unobstructed. 
we  can  readily  detect  the  interstitial  enlargement  and  exaggerated 
convolutions  that  have  been  looked  upon  as  an  after-excuse  for  many 
unnecessary  amputations.  Such  a  condition  is  as  surely  curable  under 
positive  vaginal  applications,  assisted  by  the  faradic  current  and  by 
subsequent  intra-uterine  treatment,  as  any  similar  catarrhal  affection 
elsewhere  in  the  body,  the  intra-uterine  treatment  being,  of  course, 
carefully  employed  with  a  view  of  increasing  the  drainage.  If,  on  the 
contrary,  a  true  pyosalpinx  be  suspected  to  exist  on  account  of  the 


CATARRHAL    AFFECTIONS    OF    UTERO-TUBAL    TRACT.  107 

discovery  of  a  cyst  in  this  situation,  the  case  is  different.  Such  an 
accumulation  of  the  muco-purulent  discharge  of  the  tube  is  usually 
due  to  an  obstruction  at  the  uterine  orifice,  and  is  not  an  ordinary 
abscess.  In  the  presence  of  such  a  case  we  are  at  once  confronted  by 
the  question  of  the  advisability  of  attempting  the  cure  of  the  chronic 
inflammation  by  electricity,  or  of  referring  the  patient  to  a  surgeon 
for  an  amputation  of  the  affected  part,  now  having  become  a 

Pyosalpinx. — The  determination  of  the  proper  course  to  pursue 
with  this  affection  is  not  easy,  particularly  when  we  dismiss  all  mere 
prejudice  in  favor  of  one  or  the  other  method  from  the  mind  and  are 
guided  solely  by  an  enlightened  care  for  the  ultimate  good  of  the 
patient.  The  considerable  number  of  instances  in  which  apparently 
closed  pus-tubes  have  been  rendered  patulous  and  capable  of  perform- 
ing their  functions  by  a  combination  of  vaginal  and  intra-uterine  treat- 
ment, coupled  with  a  statement  recently  made  by  Dr.  J.  M.  Baldy, 
an  uncompromising  advocate  of  the  knife,  that  many  tubes  removed 
for  pus  accumulation  are  found  to  contain  none  at  the  time  of  opera- 
tion, should  all  tend  to  check  a  too  hasty  amputation  of  a  yet  curable 
organ.  Should  the  tube,  on  the  other  hand,  be  firmly  fixed  by  well- 
organized  adhesions,  and  be  the  seat  of  an  active  accumulation  of  true 
pus  rather  than  muco-pus,  the  chances  for  a  cure  by  the  ordinary 
electric  treatment  are  very  remote.  As  a  rule,  my  own  practice  is  to 
regard  pus-tubes  of  distinctly  gonorrheal  origin  as  inadmissible  of 
cure  in  this  way,  and  yet  the  following  cases  would  seem  to  set  aside 
this  conclusion  to  some  extent: — 

Illustrative  Cases. — Mrs.  X.,  the  mother  of  three  children,  the 
youngest  of  which  was  three  years  old,  came  to  me  after  she  had  been 
advised  to  submit  to  an  operation  for  the  removal  of  the  appendages. 
Her  ill  health  dated  from  the  birth  of  the  youngest  child,  but  had 
been  much  worse  for  a  year  past.  She  had  constant  pain  in  the  back 
and  pelvis  and  was  so  lame  in  the  left  leg  that  walking  was  difficult 
and  accompanied  by  an  ungainly  limp.  The  uterus  was  found  to  be 
large  and  exuding  considerable  foul-smelling  muco-pus,  and  there  was 
a  partly-fluctuating  lump  on  either  side  of  the  fundus,  particularly  the 
left,  which  could  be  made  out  as  enlarged  and  sacculated  tubes.  After 
admission  to  the  sanatorium  her  physician  was  sent  to  me  by  the  hus- 
band to  state  that  her  condition  was  mainly  due  to  a  gonorrhea  which 
she  had  contracted  about  a  year  before.  She  was  placed  on  the 
vaginal  and  intra-uterine  treatment  described  above,  the  intra-uterine 


108  DISEASES    OF    WOMEN. 

applications  being  given  with  an  elastic,  cotton-covered  electrode, 
followed  by  rest  in  bed  for  twenty-four  hours.  At  first  the  cotton  was 
saturated  with  a  foul  and  bloody  discharge  after  each  treatment,  but 
at  the  end  of  six  weeks  there  was  great  improvement  in  every  symp- 
tom, and  she  ultimately  regained  the  power  to  walk  indefinitely  with- 
out limping  and  the  local  evidences  of  abnormality  were  greatly 
lessened. 

Mrs.  S.  J.,  aged  32,  the  mother  of  four  children,  the  youngest  of 
which  was  4  years  old,  applied  at  the  Howard  Hospital  for  treatment 
August  12,  1889.  She  had  not  been  well  since  the  birth  of  the  last 
baby,  having  had  a  vulvar  abscess  when  it  was  three  weeks  old,  and 
suffering  from  pain  in  the  back  and  on  micturition,  and  with  a  bear- 
ing-down sensation  since.  Menstruation  was  regular,  preceded  and 
followed  by  an  irregular  leucorrhea.  Examination  showed  the  uterus 
to  be  of  normal  size,  pushed  forward,  and  partly  fixed  by  a  mass  in  the 
left  tubal  region,  which  was  quite  tender.  She  received  eight  negative 
vagino-abdominal  applications  of  the  galvanic  current  during  the  fol- 
lowing month,  at  the  end  of  which  time  the  pain  and  lump  had  dis- 
appeared and  the  leucorrhea  was  greatly  lessened.  January  2,  1890, 
she  reported  herself  three  months'  pregnant. 

Mrs.  K.  D.,  aged  28,  applied  at  the  Howard  Hospital  August  27, 
1889,  complaining  of  having  been  unwell  since  shortly  after  the  birth 
of  her  only  child,  five  years  before.  There  were  sharp,  lancinating 
pains  in  the  regions  of  both  ovaries,  with  a  sensation  of  falling  of  the 
womb.  Menstruation  appeared  only  every  other  month,  and  there 
was  no  leucorrhea  at  this  time.  Examination  showed  fixation  of  the 
uterus  and  fullness  in  both  broad  ligaments.  Two  vagino-abdominal 
negative  galvanic  applications  were  made,  when  she  reported  that 
there  was  considerable  intermittent  leucorrhea.  An  electrode  was 
now  passed  within  the  uterine  cavity,  finding  it  three  inches  deep, 
and  35  milliamperes,  negative,  applied.  After  this  had  been  repeated 
once  a  menstruation  occurred  in  the  off-month,  preceded  by  an  offen- 
sive chocolate-colored  discharge  and  followed  by  symptomatic  improve- 
ment. Two  subsequent  intra-uterine  applications  were  made,  and  the 
patient  reported  a  profuse,  3'ellow  discharge  which  came  on  in  a  gush 
after  the  second  application.  ISTo  further  treatment  was  given,  as  she 
reported  herself  as  well;  the  bogginess  in  the  tubal  region  had  dis- 
appeared and  the  uterus  was  normal  in  size.    December  12,  1889,  she 


CATARRHAL    AFFECTIONS    OF    UTERO-TCBAL    TRACT.  109 

reported  at  the  clinic  as  still  well  and  in  the  second  month  of  preg- 
nancy. 

It  should  be  repeated,  however,  that  Apostoli,  Gautier,  Goelet, 
and  other  workers  are  particular  to  warn  against  high  currents  or  vio- 
lent procedures  in  inserting  the  electrode  in  these  conditions  as  likely 
to  precipitate  an  intolerance  to  electricity,  particularly  if  the  uterine 
end  of  the  tube  is  incapable  of  being  opened  by  a  resolution  of  the 
inflammation,  or  if  the  inflammation  is  too  acute. 

In  cases  incapable  of  resolution  and  drainage  through  the  natural 
channels  Goelet  strongly  urges  vaginal  electro-puncture  and  drainage 
through  the  opening  thus  made,  provided  the  pus-tube  is  low  down, 
adherent,  and  easily  reached  through  the  vagina  for  aspiration.  The 
recent  tendency  among  abdominal  surgeons  to  avoid  the  abdominal 
route  of  major  operation  in  favor  of  the  vaginal  for  such  cases  seems 
extremely  reasonable  and  in  a  line  with  this  mode  of  employing  elec- 
tricity as  an  adjunct  to  opening  and  drainage.  He  describes  the 
method  as  follows^: — 


VJ3 

Fig.  29rt. — Goelet's  platinum  cannnla-electrode. 

"The  cut  (Fig.  29a)  shows  the  platinum  cannula  electrode  (No.  4, 
French  catheter  scale)  for  the  galvano-tapping  of  pyosalpinx  through 
the  vagina.  The  shaft  is  covered  with  an  adjustable  sheath  (J.)  of 
hard  rubber  for  insulation.  This  may  be  fixed  at  any  point  by  the 
screw  {B),  and  the  degree  of  penetration  limited.  At  C  there  is  a 
three-way  stop-cock,  and  at  Z)  a  connection  for  an  irrigator,  as  well  as  a 
socket  for  connecting  with  the  battery.  When  the  trocar  (jF)  is  with- 
drawn, an  aspirator  may  be  attached  to  the  rubber  tubing  (£"),  and, 
after  the  pus  has  been  drawn  off  by  a  quarter-turn  of  the  stop-cock 
(C),  the  cavity  may  be  flushed  with  an  antiseptic  solution  passing  in  at 
D  through  the  cannula.  By  turning,  the  stop-cock  straight  again  the 
fluid  is  allowed  to  escape  through  the  tubing  {E)  into  the  aspirator- 
bottle.    Care  must  be  observed  not  to  overdistend  the  Fallopian  tube. 


* 'International  System  of  Electro-Therapeutics/'  page   G-116.     Philadel- 
phia:   The  F.  A.  Davis  Co. 


110  DISEASES    OF    WOMEN. 

the  walls  of  which  have  been  much  weakened  in  some  cases.  That  I 
may  not  be  misunderstood,  I  will  say  that  I  limit  the  degree  of  pene- 
tration usually  to  one  centimetre,  and  deem  the  procedure  appropriate 
only  when  the  tube  is  close  to  the  vaginal  wall,  full,  and  tense,  de- 
manding immediate  interference. 

"The  aspirating  cannula  is  small,  penetrates  easily,  and  the  in- 
sulating sheath  can  be  adjusted,  by  means  of  a  set-screw,  so  as  to  limit 
the  extent  of  penetration  to  any  degree  desired.  The  method  of  appli- 
cation is  as  follows:  Having  fixed  the  degree  of  penetration,  the  point 
of  the  trocar  is  drawn  within  the  cannula  to  avoid  wounding  the 
vagina  or  the  finger  along  which  the  instrument  is  inserted  as  a  guide. 
The  vagina  and  vulva  are  rendered  thoroughly  aseptic  by  a  douche 
of  creolin  or  lysol  solution,  the  index  finger  is  inserted  into  the 
vagina  against  the  most  dependent  or  prominent  portion  of  the  sac, 
which  is  held  firmly  in  position  by  pressure  from  above  on  the  abdo- 
men (this  will  not  be  necessary  if  the  sac  is  already  firmly  fixed  by 
adhesions),  and  the  instrument  is  introduced  along  the  finger  and 
plunged  into  the  sac;  removing  the  trocar,  the  pus  is  withdrawn  and 
the  cavity  irrigated  with  an  antiseptic  solution.  The  cannula  is 
arranged  with  a  two-way  stop-cock,  which  allows  this  to  be  accom- 
plished readily,  but  care  is  necessary,  when  the  tube  is  not  adherent, 
to  prevent  leakage  into  the  peritoneal  cavity.  The  solution  should 
flow  from  a  reservoir  of  moderate  elevation,  and  much  distension  of 
the  sac  must  be  avoided.  The  stop-cock  turned  in  one  direction  allows 
an  inflow,  and  a  quarter-turn  in  another  direction  an  outflow,  so 
that  thorough  irrigation  is  possible.  The  penetration  of  the  cannula 
is  limited  by  the  insulating  sheath  and  a  set-screw.  It  is  arranged  to 
allow  a  penetration  of  one  centimetre,  but  half  a  centimetre  is  usually 
sufficient. 

"Before  withdrawing  the  cannula  it  is  connected  with  the  posi- 
tive pole  of  the  battery  and  a  current-strength  of  50  milliamperes  is 
used  for  five  minutes.  This  pole  is  preferred  because  of  its  well- 
known  antiseptic  properties,  which  are  due  to  the  liberation  of  oxygen 
and  chlorine.  Its  peculiar  reaction  destroys  the  character  of  the  pyo- 
genic membrane  and  promotes  resolution  in  the  sac-walls  and  sur- 
rounding structures.  The  cauterization  of  the  track  of  the  cannula 
shuts  it  off  from  the  tissues  which  are  penetrated,  whereby  extrava- 
sation and  absorption  of  septic  material  are  prevented.  When  the 
tube  is  not  adherent  the  peritoneal  cavity  is  penetrated,  but  the  sub- 


CATAKRHAL   AFFECTIONS    OF    UTEKO-TUBAL    TRACT.  Ill 

sequent  cauterization  induces  an  immediate  adhesion  of  the  perito- 
neal surfaces  around  the  puncture,  which  effectually  closes  it  from 
outside  influences  of  an  injurious  nature.  Sufficient  drainage  will 
ordinarily  be  afforded  through  the  puncture-track,  but,  when  neces- 
sary, it  may  be  facilitated  subsequently  by  passing  a  small  probe  or 
sound-electrode  connected  with  the  negative  pole  to  enlarge  the  track 
(10  to  15  milliamperes  will  be  sufficient).  This  operation  should  be 
performed  only  at  the  patient's  house,  and  she  should  be  put  to  bed 
immediately  after.  A  loose  dressing  of  iodoform  or  aristol  gauze  i? 
placed  in  the  vagina,  and  renewed  every  day  or  two,  when  a  hot  douche 
of  a  1-per-cent.  solution  of  creolin  is  given. 

"The  subsequent  management  of  the  case  and  the  treatment  nec- 
essary will  be  suggested  by  the  condition  remaining  after  evacuation 
of  the  abscess.  Galvanization  with  the  positive  pole  in  the  vagina  will 
promote  resolution  of  the  surrounding  structures,  and  the  negative 
pole  may  be  employed  to  hasten  the  absorption  of  deposits  or  soften 
and  relax  adhesions  which  interfere  with  the  necessary  mobility  of  the 
pelvic  organs.  Treatment  of  the  co-existing  endometritis  must  not 
be  neglected.  It  is  seldom  possible  to  restore  an  absolutely  normal 
condition;  nor  is  it  attained  by  the  alternative, — laparotomy, — but  a 
condition  quite  conducive  to  health,  comfort,  and  usefulness  may  be 
brought  about.  Can  as  much  be  said  of  the  radical  operation,  which 
deprives  the  patient  of  organs  essential  alike  for  her  usefulness  and 
happiness?" 

Hematosalpinx. — This  condition  is  not  easily  distinguished  from 
pyosalpinx  except  by  its  recent  appearance.  In  a  thoroughly  con- 
ducted transillumination  of  the  pelvis  a  dark  cloud  will  be  found  in 
the  situation  of  the  tubes  in  both  affections.  Hematosalpinx  is  now 
thought  to  be  an  arrested  tubal  pregnancy  in  some  cases.  Being  but 
an  effusion  of  blood  or  of  blood  and  mucus,  the  proper  treatment  is 
a  promotion  of  its  absorption  by  negative  vaginal  galvanic  applica- 
tions, the  intravaginal  electrode  being  pressed  against  the  tumor  as  in 
the  treatment  of  ectopic  gestation.  Several  weeks'  daily  treatment 
with  current-strengths  of  50  milliamperes  will  usually  be  found  suffi- 
cient to  cause  material  shrinkage.  In  case  this  fails  the  method  just 
detailed  for  pyosalpinx  may  be  employed  under  antiseptic  precautions, 
though  I  refrain  from  advising  it.  An  abdominal  section  for  an 
accumulation  of  material  so  easily  absorbed  as  this  is  totally  unjusti- 
fiable. 


112  DISEASES    OF    WOMEN. 

Hydrosalpinx. — This  condition  may  be  approximately  distin- 
guished from  pyo-  and  hemato-  salpinx  by  the  absence  of  tenderness 
and  adhesions  and  by  its  long-standing  character.  Under  transillumi- 
nation no  cloudiness  is  observable  in  the  situation  of  the  tumor.  Aspi- 
ration, followed  by  a  galvanic  application  to  the  cavity,  will  usually 
insure  a  thorough  cure. 

Pelvic  Peritonitis. — This  condition  is  usually  consecutive  to 
catarrhal  disease  of  the  uterus  and  tubes.  The  therapeutic  manage- 
ment of  an  acute  attack  by  the  ordinary  antiphlogistic  measures,  such 
as  ice,  iodine,  etc.,  to  the  abdominal  aspect  of  the  swelling  may  be 


Fig.  30. — Line  of  rigidity  in  pelvic  peritonitis.     (Thomas  and  Mund6.) 


greatly  assisted  by  the  use  of  Apostoli's  suggestion  of  bipolar,  fine- 
wire,  faradic  applications  within  the  vagina,  as  in  the  acute  cases  of 
salpingitis  and  ovaritis.  No  pain  whatever  should  be  produced  either 
in  inserting  the  warmed  electrode  or  by  the  current,  the  latter  being 
turned  on  very  gradually  and  used  for  fifteen  minutes  daily,  if  relief 
of  pain  is  gained.  The  cessation  of  pain  by  this  means  can  only  indi- 
cate more  or  less  arrest  of  the  congestive  process  attending  the  advance 
of  the  inflammation. 

In  the  treatment  of  the  later  stages  of  the  acute  process  the 
bipolar  faradic  current  is  also  most  useful,  to  which  should  be  added 
positive  galvanic  vagino-abdominal  applications  in  the  more  chronic 


CATAKRHAL    AFFECTIONS    OF    UTERO-TUBAL    TRACT.  113 

cases.  The  rajDidity  with  which  the  exudation  forming  the  board-like 
vault  of  the  vagina,  encountered  by  the  finger  in  a  plane  represented 
by  the  dotted  line  in  Fig.  30,  may  be  made  to  disappear  under  this 
treatment  is  often  astonishing,  even  when  the  agglutination  of  the 
pelvic  organs  is  of  long  standing.  The  following  case  is  an  excellent 
example : — 

Illustrative  Case. — A  married  lady,  37  years  old,  was  referred  to 
me  by  Dr.  J.  A.  Draper,  of  Wilmington,  Del.  She  had  had  a  miscar- 
riage seven  years  before  and  various  attacks  of  probably  specific 
vaginitis  since,  culminating  in  metrosalpingitis  and  pelvic  peritonitis. 
Under  the  pain  of  the  latter  condition  she  was  fast  developing  an 
opium  habit.  Examination  revealed  an  enlarged  uterus  set  in  a  hard- 
ened pelvic  vault  just  as  if  plaster  of  Paris  had  been  poured  over  it, 
as  described  by  Thomas  and  Munde.  She  was  admitted  to  the  sana- 
torium on  March  25,  1891,  and  placed  on  negative  vagino-abdominal 
applications  of  75  milliamperes,  occasionally  changing  to  galvanic 
alternatives  in  the  same  situation,  together  with  the  general  rest-cure 
treatment.  By  May  5th  she  was  symptomatically  well,  and  my  notes 
speak  of  great  loosening  of  the  uterus,  though  slight  tenderness  per- 
sisted to  the  left  of  the  uterus.  Several  ofhce  applications  were  made 
during  the  following  month,  and  on  October  2d  it  is  noted  that  the 
uterus  is  quite  small  and  movable,  and  that  no  symptoms  remain.  This 
lady  was  seen  five  years  later  in  the  best  of  health,  which  she  attributed 
to  the  treatment  received. 


CHAPTEK  IX. 
Chronic  Inflammatory  Affections  of  the  Ovaries. 

Chronic  Ovaritis. — The  unexampled  opportunities  of  studying 
inflammatory  afl:ections  of  the  ovaries  after  their  operative  removal, 
recently  enjoyed  by  the  younger  school  of  gynecic  surgeons,  might 
have  yielded  greater  good  to  pathologic  science  than  to  some  of  the 
patients  operated  upon  had  the  bucketfuls  of  specimens  brought  to 
the  societies  been  thoroughly  studied.  As  it  is,  the  most  important 
lesson  taught  by  this  misdirected  energy,  aside  from  its  evidence  of 
the  cyclonic  character  of  variations  in  professional  opinion,  is  that 
ovarian  and  tubal  affections  are  not  easily  differentiated  from  each 
other  prior  to  operation,  and  that  it  is  equally  difficult  to  distinguish 
a  curable  from  an  incurable  disease  of  these  organs  by  a  simple  ex- 
amination. The  great  majority  of  ovaries  and  tubes  thus  hastily  con- 
demned to  extirpation  are  found  after  removal  to  be  the  seat  of  simple 
inflammation,  and  their  unfortunate  destruction  is  a  heavy  tax  to  pay 
for  a  relatively  small  number  of  cases  incurably  diseased  thus  dis- 
covered. 

A  means  of  practically  averting  this  causeless  unsexing  of  women 
has  been  recently  indicated  by  Apostoli,  the  careful  application  of 
which  should  do  much  to  confine  castrational  operations  within  their 
legitimate  limits  of  the  removal  of  useless  organs.  This  consists  in 
diagnostic  test-treatments,  which,  by  aggravating  the  symptoms,  make 
out  a  clear  diagnosis  of  a  condition  demanding  operation,  or  by  amel- 
iorating the  symptoms,  indicate  infallibly  the  presence  of  a  curable 
lesion. 

This  diagnostic  test  comprises  two  procedures:  a  bipolar  faradic 
application  and  an  intra-uterine  galvanic  application.  If  the  former 
relieves  the  pain  at  once,  or  after  several  sittings,  the  probability  is 
that  the  condition  is  neuralgic  or  congestive  and  scarcely  inflamma- 
tory even.  If  an  intra-uterine  application  of  35  to  50  milliamperes, 
(114) 


AFFECTIONS    OF    THE    OVARIES.  115 

made  with  a  covered/  elastic  electrode,  aggravates  the  pain  greatly  and 
persistently,  the  possibilities  are  strongly  in  favor  of  a  grave  inflam- 
mation of  the  adnexa  that  indicates  operative  procedures.  There  is, 
of  course,  some  discomfort  under  the  second  test  even  in  curable  cases, 
and  this  is  more  pronounced  if  the  electrode  be  rigid  and  inserted 
with  harshness,  but  the  modification  of  Apostoli's  method  which  I 
employ,  consisting  in  the  use  of  an  elastic  electrode,  constitutes  a  most 
delicate  test,  as  the  pain  reaction  of  such  an  application  is  at  a  mini- 
mum in  cases  amenable  to  electricity. 

In  my  own  practice  such  a  test  is  rarely  applied  in  this  way,  since 
I  am  convinced  that  many  inflammations  of  the  tubes  and  ovaries  are 
capable  of  relief  by  electricity  applied  by  the  vagino-abdominal 
method  that  would  be  aggravated  by  intra-uterine  applications.  It  is 
only,  therefore,  when  a  vagino-abdominal  or  bipolar  faradic  applica- 
tion fails  to  give  relief,  and  a  simple  vagino-abdominal  positive  gal- 
vanic application  aggravates  the  pain,  that  a  conclusion  is  arrived  at 
that  the  condition  is  one  that  is  impossible  to  cure  in  this  way;  for 
an  intolerance  of  such  treatment  surely  indicates  too  advanced  a 
process,  with  suppurative  consequences,  tuberculosis  of  these  organs, 
or  other  incurable  local  faults. 

As  already  remarked,  the  differential  diagnosis  between  chronic 
catarrhal  salpingitis  and  simple  chronic  ovaritis  is  difficult  of  estab- 
lishment with  absolute  certainty,  either  from  the  subjective  symptoms 
or  by  the  bimanual  examination,  but  the  electric  treatment  of  the 
minor  stages  of  either  condition  is  practically  the  same.  The  treat- 
ment, in  other  words,  is  directed  to  the  inflammation  itself,  the  cur- 
rent promoting  absorption  of  the  interstitial  effusion  as  well  as  of 
edematous  and  serous  collections  whether  situated  in  the  tubes  or 
ovaries.  Such  a  method  is  necessarily  interpolar  and  but  slowly  effect- 
ive in  some  cases,  but  the  importance  of  the  results  that  can  generally 
be  secured  is  very  great  and  well  worth  the  time  and  labor  expended. 

The  applications  should  be  made  daily  or  thrice  weekly  with  both 
currents,  the  positive  pole  of  a  30-  to  60-  milliampere  current  being 
employed  for  five  minutes,  followed  by  a  medium  or  fine- wire,  faradic 
current  of  the  same  duration,  without  removing  the  electrode.     The 


^  The  use  of  a  covered  elastic  electrode  makes  this  test  more  delicate  than 
contemplated  by  Apostoli,  eliminating  the  mechanical  harshness  of  a  stiff 
sound. 


116  DISEASES    OF    WOMEN. 

latter  should  be  a  carbon  or  zinc  vaginal  instrument  covered  with 
absorbent  cotton,  wet  and  soaped,  and  gently  pressed  against  the  ovary 
through  the  vagina.  After  turning  the  faradic  current  off  the  elec- 
trode may  be  gently  shifted  to  the  other  side,  if  both  ovaries  be 
affected,  and  this  current  again  turned  on,  though  it  is  wisest  to  re- 
serve the  galvanic  current  in  this  situation  till  the  next  seance,  alter- 
nating the  sides  for  its  application.  Each  application  should  be  fol- 
lowed by  repose  in  bed  when  this  is  practicable. 

Under  this  treatment  the  pain  and  tenderness  lessen  and  adherent 
ovaries  become  looser  through  absorption  of  the  bands  of  exudate, 
the  symptomatic  improvement  proceeding  with  equal  pace  with  the 
trophic  and  vascular  restoration.  From  six  weeks  to  six  months  will 
usually  be  required  to  attain  such  results. 

A  more  serious  condition  is  present  if  the  ovaries  become  pro- 
lapsed by  reason  of  increased  weight  and  the  dragging  effect  of  adhe- 
sions from  attacks  of  circumscribed  peritonitis.  In  this  state  the 
wisdom,  of  sacrificing  the  organs  by  removal  becomes  a  question  of 
importance,  as  their  dislocated  position  renders  them  more  subject  to 
relapses  and  aggravations  of  the  inflammation.  It  should  be  remem- 
bered, however,  that  the  suffering  is  entirely  due  to  the  ovaritis  and 
other  inflammatory  conditions  preceding  and  accompanying  it,  often 
to  a  still  existing  endometritis  or  metritis,  and  that  if  we  can  restore 
the  parts  to  a  healthy  condition  in  this  respect  a  symptomatic  cure 
may  be  attained,  even  though  it  be  impossible  to  restore  the  organs  to 
their  proper  position.  The  fact  that  the  dislocated  position  of  the 
organs  renders  pregnancy  unlikely  because  of  the  lack  of  co-aptation 
of  the  fimbriated  end  of  the  tube  to  the  ovary  is  no  real  argument  in 
favor  of  the  removal,  as  one  can  never  be  sure  that  the  tube  is  not 
equally  displaced  and  thus  capable  of  performing  its  functions  if 
rendered  free  to  move.  An  incurable  tenderness  or  painfulness  is  the 
only  practical  or  reasonable  indication  for  castration.  That  a  perma- 
nent symptomatic  cure  of  ovaritis  complicated  by  prolapse  of  the 
organ  may  be  attained  is  attested  by  the  following  cases,  which  have 
been  under  observation  for  some  time  since  the  cessation  of  treat- 
ment:— 

Illvsirative  Cases. — A  young  lady,  aged  21,  was  sent  to  me  by 
Dr.  John  Chambers,  of  Kingston,  N.  Y.,  ]\ray  20,  1892,  with  the  fol- 
lowing history:  Her  mother  died  of  phthisis  and  her  father  and  a 
brother  of  Bright's  disease.     She  herself  had  always  been  delicate, 


AFFECTIONS    OF    THE    OVARIES.  117 

particularly  since  puberty,  which  appeared  late  and  irregularly, 
quickly  developing  intense  menorrhalgia.  At  18  she  was  sent  to  Dr. 
T.  Gaillard  Thomas,  who  inserted  a  pessary,  which  relieved  her  for  a 
time,  but  subsequently  gave  rise  to  much  suffering.  Returning  to  Dr. 
Thomas  in  1891,  she  was  placed  under  treatment  at  the  Woman's  Hos- 
pital, where  oophorectomy  was  advised  after  a  period  of  treatment. 

Her  general  condition  on  admission  to  the  sanatorium  was  poor, 
evidencing  malassimilatiou  and  some  nervous  prostration.  The  prin- 
cipal symptoms  of  discomfort  were,  however,  directly  traceable  to  the 
pelvic  condition.  The  sitting  posture,  and  particularly  the  use  of  a 
rocking-chair  aggravated  the  discomfort  and  pain  in  the  pelvis,  which 
was  constant  between  periods  and  extreme  during  the  flow.  Leucor- 
rhea  had  been  quite  bad  since  the  pessary  was  inserted.  The  menstrual 
periods  were  profuse,  with  worst  pain  on  first  and  third  days.  Exami- 
nation showed  tender  and  prolapsed  ovaries,  the  left  being  enlarged 
and  lowest,  with  enlarged  and  prolapsed  uterus,  the  latter  being  near 
the  pelvic  outlet  and  exuding  a  copious  leueorrhea.  The  uterine 
cavity  measured  three  and  one-fourth  inches.  Much  pain  was  devel- 
oped by  the  examination. 

She  was  placed  on  positive  vagino-abdominal  applications  of  50 
milliamperes,  followed  by  the  secondary  faradic  current  in  the  same 
situation  and  general  galvanic  stimulation;  the  applications  to  be  made 
daily,  followed  by  rest.  Great  amelioration  of  the  tenderness  of  the 
left  ovary  followed.  At  the  end  of  the  second  week  a  mild  intra- 
uterine positive  application  with  a  covered  elastic  electrode  was  made, 
and  repeated  once  in  seven  days  during  the  remainder  of  the  treat- 
ment, which  was  continued  for  two  months.  On  discharge  her  condi- 
tion Avas  so  satisfactory  that  a  symptomatic  cure  was  noted. 

In  a  letter  dated  February  3,  1896,  more  than  three  years  after 
the  end  of  the  treatment,  this  lady  reports  herself  in  the  best  of  health,, 
which  she  attributes  entirely  to  the  methods  employed.  I  have  un- 
fortunately no  notes  of  the  size  of  the  uterus  or  position  of  the  ovaries 
subsequent  to  the  treatment,  but  regard  this  defect  in  the  record  a& 
of  less  importance  than  accurate  statements  of  the  ultimate  result  in 
the  restoration  of  conscious  health. 

A  more  difficult  case  was  that  of  a  married  lady  of  27,  referred 
to  me  by  Dr.  Potter,  of  Germantown,  October  25,  1893.  This  lady 
was  the  picture  of  robust  health  in  spite  of  an  hypertrophied  uterus 
and  deeply  prolapsed  ovaries,  the  latter  being  enlarged,  tender,  and 


118  DISEASES    OF    WOMJIN. 

giving  her  much  discomfort  when  walking  or  riding.  The  trouble 
dated  back  to  a  prolonged  labor  followed  by  laceration  of  the  cervix, 
for  which  a  repair  operation  had  been  done  by  a  distinguished  sur- 
geon. There  was  a  copious  muco-purulent  leucorrhea.  In  spite  of 
the  excellent  union  of  the  cervix  obtained  in  the  plastic  operation 
the  uterine  body  remained  hyperplastic,  the  seat  of  an  unpleasant  dis- 
charge, and  had  a  cavity  measuring  more  than  three  inches  in  depth. 
The  menstruation  was  irregular,  appearing  in  periods  of  thirty-one 
and  forty-one  days. 

Vagino-abdominal  treatment  seemed  to  be  of  little  service  in  this 
case,  probably  because  the  ovaries  were  not  the  principal  seat  of  the 
trouble,  though  out  of  place,  and  it  was  necessary  to  attack  the  uterine 
trouble  by  intra-uterine  galvanic  applications.  Owing  to  the  great 
increase  of  tenderness  evoked  by  these  applications,  which  were  nega- 
tive and  applied  by  the  covered  elastic  electrode,  not  more  than  35 
milliamperes  were  used,  and  generally  less,  twice  a  week,  followed  by 
the  contracting,  primary  faradic  current  to  the  point  of  tolerance,  then 
by  a  bipolar  secondary.  As  a  result,  the  leucorrheal  discharge  was 
cured,  but  when  the  patient  ceased  attendance  the  symptomatic  cure 
and  reduction  of  bulk  were  still  imperfect.  It  is  possible  that,  had  this 
patient  realized  the  importance  of  long-continued  and  regular  treat- 
ment, as  good  results  would  have  been  attained  as  in  the  following 
•case: — 

Mrs.  J.  F.,  aged  31,  applied  for  treatment  at  the  Howard  Hospital 
clinic  May  7,  1896,  with  the  following  history:  Her  only  child  was 
]  1  years  old.  Eight  years  ago  she  had  miscarried  and  had  been  an 
invalid  ever  since,  having  had  vaginitis  of  probably  gonorrheal  origin 
about  the  time  of  the  miscarriage.  She  had  received  the  usual  treat- 
ment, including  pessaries,  which  gave  so  much  discomfort  as  to  compel 
their  discontinuance,  and  the  advice  that  her  ovaries  should  be  re- 
moved was  given  at  several  hospitals.  There  was  but  slight  leucorrhea 
at  this  time. 

Examination  showed  an  enlarged  and  flabby  uterus,  somewhat 
retroposed,  with  tender  tubal  regions  and  distinctly  prolapsed  and 
enlarged  ovaries. 

She  was  placed  on  vaginal  positive  galvanic  applications  of  about 
50  milliamperes  three  times  a  week.  This  was  continued  with  great 
regularity  for  three  months,  during  which  time  distinct  improvement 
was  noted  in  both  the  subjective  and  objective  symptoms.    On  August 


AFFECTIONS    OF    THE    OVARIES.  119 

11th  the  tenderness  had  so  far  abated  that  it  was  considered  wise  to 
begin  intra-uterine  applications  of  40  milliamperes,  positive,  followed 
by  the  fine-wire  secondary.  This  was  well  borne,  and  was  continued 
at  weekly  intervals  for  three  months.  In  the  latter  part  of  January, 
1897,  the  patient  had  the  pleasure  of  realizing  that  she  was  not  only 
restored  to  complete  subjective  health,  but  was  also  pregnant  for  the 
first  time  in  nine  years.  Her  health  continued  excellent  under  this 
trying  ordeal,  and  in  October,  1897,  she  was  delivered  after  a  remark- 
ably short  and  painless  confinement. 

Ovarian  Congestion. — Aside  from  these  marked  instances  of  phys- 
ical deviations  from  the  normal  size  and  position  of  the  ovaries  we 
have  also  a  numerous  class  of  cases  among  young  women  who  com- 
plain of  pain  and  tenderness  in  one  or  both  ovarian  regions  so  little 
accompanied  by  other  evidences  of  physical  disease,  such  as  persistent 
leucorrhea,  as  to  render  a  physical  examination  both  unnecessary  and 
unwise.  These  cases,  well  described  by  Skene  in  his  recent  work,^  are 
but  derangements  of  function  unaccompanied  by  structural  changes 
of  the  organs^  though  generally  accompanied  by  congestion  or  hyper- 
emia. It  is  usually  thought  that  conditions  of  life  favoring  excitation 
of  the  sexual  function  without  complete  functionation  (as  in  morbidly 
introspective  girls,  unhappily  married  and  childless  women,  and  wid- 
ows) are  the  principal  predisposing  conditions,  but  I  have  observed 
the  affection  frequently  where  these  conditions  are  replaced  by  causa- 
tive factors  depending  on  nutritive  disturbances  of  all  the  vegetative 
functions  of  life,  including  vasomotor  irregularity,  constipation, 
lithemia,  neurasthenia,  and,  of  course,  hysteria.  There  can  be  no 
question,  though,  of  the  tendency  of  this  condition,  left  to  itself,  to 
develop  into  genuine  chronic  ovaritis;  hence  it  is  important  to  direct 
attention  to  the  local  condition  as  well  as  the  general  nervous  disorder. 

Together  with  a  removal  of  the  cause  or  causes  and  regulation  of 
the  alimentary  functions,  there  is  no  form  of  treatment  for  persistent 
cases  of  ovarian  hyperemia  equal  to  external  abdomino-dorsal  appli- 
cations of  both  currents  accompanied  by  a  Judicious  course  of  the  rest 
treatment,  inclusive  of  general  galvanic  stimulation  and  massage;  pro- 
vided this  be  carried  out  in  a  properly-regulated  institution  and  away 
from  the  accustomed  scenes  of  home  and  overzealous  friends.     The 


^  "Medical  Gynecology,"  by  Alexander  J.  C.  Skene,  page  220.    D.  Appleton 
&  Co. 


120  DISEASES    OF    WOMEN. 

rest  cure  at  home  is  usually  thoroughly  impracticable  in  its  essential 
features,  and  even  under  the  most  favorable  conditions  for  its  employ- 
ment it  must  be  associated  with  the  local  external  treatment  described 
in  order  that  permanent  results  may  be  attained.  Skill  in  managing 
such  cases  is  only  attained  by  physicians  who  understand  that  a  large 
proportion  of  the  work  in  the  diseases  of  women  demands  a  combina- 
tion of  the  skill  of  the  neurologist  with  that  of  the  gynecologist. 


CHAPTEK  X. 

Fibroid  Tumors. 

Probably  the  best  definition  of  a  fibroid  tumor  of  the  uterus 
may  be  adapted  from  Colmlieim  as  a  localized  increase  of  tissue  similar 
in  structure  to  the  uterine  body,  hut  the  product  of  embryonic  cells  of 
congenital  origin,  produced  independently  of  microbic  causes,  and  of  a 
benign  character.  Spoken  of  generally  in  English-speaking  countries 
as  fibroids  or  myofibromata,  they  are  strictly  termed  fibromas  if  the 
fibrous  tissue  natural  to  the  uterine  wall  predominates,  or  myomas  if 
the  muscular  tissue  predominates. 

They  arise  within  the  wall  of  the  corpus  usuall}^  rarely  in  that 
of  the  cervix,  and  push  aside  the  normal  tissues  in  their  growth,  being 
thus  encapsulated,  and  do  not  blend  with  or  invade  the  normal  tissue 
as  is  the  case  with  malignant  tumors. 

Origin. — The  most  reasonable  theory  of  the  origin  of  fibroid 
tumors  is  that  of  Cohnheim,^  who  advanced  the  hypothesis  that  they 
arise  from  a  matrix  of  embryonic  cells  of  fetal  origin  which  have 
failed  to  develop  into  mature  cells  like  those  surrounding  them.  These 
cells  are  supposed  to  have  remained  dormant  during  the  growth  of 
the  general  body-structures  on  account  of  the  physiologic  resistance 
presented  by  more  highly  developed  tissues  surrounding  them.  Should 
this  physiologic  resistance  of  the  environment  remain  in  a  normal 
condition,  the  remnant  of  fetal  structures  continues  dormant  as  a  "fetal 
rest."  Should,  on  the  other  hand,  this  physiologic  resistance  of  the 
surrounding  tissues  be  lessened  by  disease,  such  as  a  microbic  invasion 
and  inflammation,  a  traumatism,  or  by  the  special  activities  of  puberty, 
the  embryonic  matrix  becomes  active  and  proliferates  in  accord  with 
its  crude  endowments,  absorbing  nourishment  froni  the  surrounding 
tissues  and  vessels.  The  tumor-matrix  is,  therefore,  prenatal,  and  may 
remain   permanently   dormant   unless   afforded   an    opportunity   for 


^  According  to  Mr.  W.  R.  Williams,  in  a  paper  read  before  the  British 
Medical  Association  at  Carlisle,  the  theory  of  the  "fetal-rest"  origin  of  tumors 
was  first  conceived  by  Professor  Durante,  of  Rome,  Italv,  in  1874. 

(121) 


123  DISEASES    OF    WOMEN. 

growth  by  influences  that  depress  the  normal  inhibiting  power  of  the 
vital  forces. 

Effects  of  Electric  Treatment  Corroborate  Colmlieim's  Theory. — 
This  theory  of  tumor-formation  bears  many  evidences  of  its  truth 
though  essentially  hypothetical,  not  the  least  of  which  is  the  excellent 
explanation  it  affords  of  the  phenomena  accompanying  the  electric 


Fig.  31. — Intramural  fibroid  tumor.     (Drawn  from  specimen  in  the  Mutter 
Museiuu  of  the  College  of  Physicians.) 

treatment  of  these  neoplasms.  It  will  be  seen  that  the  two  elements 
essential  to  the  existence  of  a  tumor  are  a  matrix  of  embryonic  cells 
and  a  released  inhibition  to  their  proliferation.  That  such  a  prolif- 
erating matrix  may  be  checked  l)y  a  trophic  blow  transmitted  to  the 
matrix  by  a  heavy  current,  or  by  an  electric  stimulation  of  the  physio- 
logic resistance  of  the  surrounding  tissues,  is  quite  evident;  and  that 


FIBROID   TUMORS. 


123 


these  are  the  two  modes  in  which  electricity  acts  upon  fibroids,  rather 
than  by  destructive  electrolysis,  I  have  long  felt  assured. 

Clinical  Varieties. — A  fibroid  tumor  grows  from  one  or  more 
congenital  matrices  within  the  tissue  of  the  uterine  wall,  pressing  the 
normal  uterine  stroma  before  it,  and  tends  to  develop  most  in  the 
direction  of  least  resistance.  If  this  centre  of  growth  appears  about 
the  middle  of  the  uterine  wall  an  equable  enlargement  of  that  portion 
of  the  uterus  results,  as  in  Fig.  31,  the  unaffected  tissues  being  dis- 
placed in  all  directions,  giving  rise  to  the  most  common  clinical 
variety,  known  as  an  intramural  tumor.  If  the  centre  of  growth  be 
nearer  the  mucous  membrane  than  the  peritoneal  covering  it  will 


Fig.  32. — Submucous  and  intramural  fibroid  tumors.     (Drawn  from  speci- 
men in  the  Mutter  Museum  of  the  College  of  Physicians.) 


in  time  project  more  or  less  into  the  uterine  cavity,  forming  the  sub- 
mucous variety  (Figs.  32  and  33),  which  may,  by  still  further  pro- 
jection into  the  cavity,  become  pedunculated,  forming  a  fibroid  polyp 
(Fig.  34).  If,  on  the  other  hand,  the  centre  of  growth  be  nearer  the 
peritoneal  surface,  it  will  again  follow  the  lines  of  least  resistance, 
and  by  projecting  into  the  peritoneal  cavity  become  subperitoneal 
(Fig.  35),  or,  by  a  complete  emergence,  become  pedunculated  (Fig.  36). 
Whether  a  given  matrix  of  growth  will  develop  into  either  of 
these  varieties  depends,  therefore,  on  its  original  situation  in  the 
uterine  parenchyma  and  the  direction  of  least  resistance  to  its  phys- 
ical encroachment.  In  growths  of  more  than  one  matrix  each  variety 
may  be  found  co-existing,  particularly  the  intramural  and  subperi- 


124  DISEASES    OF    WOMEN. 

toneal,  and  an  intramural  tumor  may  later  take  on  the  characteristics 
of  either  a  submucous  or  subperitoneal  form  as  it  emerges  from  either 
surface. 

Certain  tumors  possess  so  many  matrices  of  development  that 
the  whole  substance  of  the  uterus  is  permeated  with  the  resulting 
growth,  which  resembles  a  symmetrically-enlarged  uterus.  This 
variety  is  known  as  the  interstitial  fibroid  (Fig.  37). 


Fig.  33. — Multinodular  fibroid  with  submucous  projections.      (Drawn  from 
specimen  in  the  Mutter  Museum  of  the   College  of  Physicians.) 

These  neoplasms,  particularly  when  the  fibrous  tissue  predomi- 
nates, are  of  very  slow  growth,  sometimes  existing  ten  or  fifteen  years 
before  becoming  abdominal  in  situation  and  large  enough  to  be  felt 
above  the  pubic  bones.  At  times,  indeed,  non-heraorrhagic  varieties 
are  not  discovered  by  either  the  patient  or  her  physician  until  they 
have  attained  a  number  of  years'  growth  and  the  size  of  a  cocoa-nut 
or  larger,  so  slight  had  been  the  symptoms  of  their  presence.    In  other 


FIBROID    TUMORS. 


125 


instances  tlie  initial  nodules,  no  larger  than  a  pea,  give  rise  to  intense 
suffering  at  a  time  in  their  history  when  they  remain  undiscovered, 
the  patient  going  through  a  fruitless  succession  of  attempts  to  be 
cured  of  suspected  ovarian  disease,  displacements,  etc. 

It  is  in  this  initial  stage  that  these  tumors  are  most  generally  and 
readily  amenable  to  electric  treatment,  not  only  because  their  small 
size  renders  equal  currents  and  periods  of  treatment  more  effective 
than  in  larger  ones,  but  because  all  such  tumors  are,  in  this  stage. 


Fig.  34. — Fibroid  polypus. 


capable  of  arrest  and  absorption,  while  some  of  them  later,  by  excess- 
ive growth,  extrusion  beyond  reach  into  the  abdominal  cavity,  or 
degeneration,  will  become  unfit  for  it. 

Any  uterus  suspected  of  being  the  seat  of  this  neoplasm  should 
be  promptly  placed  under  the  Apostoli  treatment  therefore,  the  treat- 
ment being  continued  until  the  diagnosis  is  either  cleared  up  nega- 
tively by  the  restoration  of  the  uterus  to  its  normal  dimensions  and 
the  disappearance  of  symptoms  with  the  cure  of  the  simple  hyper- 
plasia that  existed,  or  iintil  a  nodule  can  be  made  out  by  the  shrinkage 


126 


DISEASES    OF    WOMEN. 


of  the  uterine  wall  surrounding  it.  In  the  latter  case  we  are  enabled 
to  make  a  diagnosis  of  an  incipient  fibroid  with  certainty  and  should 
continue  the  applications  for  a  longer  period  to  bring  about  a  still 
farther  retrogression,  or  a  possible  disappearance,  of  the  tumor  itself. 
It  is  fortunate  that  the  applications  essential  to  the  cure  of  simple 


Fig.   35. — Subperitoneal  fibroid  with  sessile   attachment  to   posterior  wall 

of  uterus.     (From  specimen  in  the  Mutter  Museum  of  the 

College  of  Physicians.) 


uterine  hypertrophy  and  of  interstitial  or  intramural  fibroids  of  small 
size  are  identical,  being  intra-uterine  applications  of  the  negative 
pole  of  from  25  to  150  milliamperes  in  non-hemorrhagic  cases,  or  of 
mercurial  cataphoresis  of  the  same  strength  and  locality  in  hemor- 
rhagic cases.  Such  an  early  recognition  and  prompt  remedy  of  a 
tedious  and  troublesome  affection,  leaving  the  patient  in  the  complete 


FIBROID   TUMORS.  127 

possession  of  both  her  health  and  her  organs,  merits  the  highest 
plaudits  conferable  on  scientific  skill;  but  unfortunately  the  human 
mind  is  so  constituted  as  to  feel  far  greater  interest  in  the  compar- 
atively gross  act  of  removing  a  palpably  large  tumor  with  the  knife, 
together  with  sundry  organs  of  precious  worth  to  a  normal  human 
being. 

Natural  Prognosis  of  Fibroid  Tumors  Without  Treatment. — 
Fibroid  tumors  are  essentially  and  strictly  benign  and  have  no  con- 
nection whatever  with  malignant  growths,  though  in  very  rare  in- 
stances they  have  been  known  to  become  the  seat  of  malignant  de- 


i 


Vih.  "■ ' 


/        1 


■t 

A 

(      >/ 
^..^ 

Fig.  36.^ — Pedunculated  subperitoneal  fibroid.      (From  specimen  in  the 
Mutter  Museum   of  the   College  of  Physicians.) 

generation  late  in  their  history.  Such  a  termination  is,  however,  so 
rare  as  to  be  a  curiosity.  The  life  of  the  patient  is  never  threatened, 
but  by  some  form'  of  degeneration,  and  it  has  only  recently  been 
appreciated  by  the  profession  that  the  deaths  after  efforts  at  removal 
by  the  knife  represent  almost  the  entire  mortality  of  these  growths. 
Apostoli's  Discovery. — The  world  is  indebted  to  Georges  Apostoli, 
of  Paris,  France,  for  the  practical  discovery  and  demonstration  that 
fibroid  growths  are  amenable  to  electricity,  though  Cutter,  of  this 
country,  had  used  this  remedy  in  fibroids  in  a  crude  manner  before 
him  and  had  called  attention  to  its  value.     Apostoli's  modest  claim. 


128 


DISEASES    OF    WOilEX. 


first  put  fonvard  in  the  early  80's,  that  electricity  will  cause  a  symp- 
tomatic cure — arrest  of  growth  and  anatomical  regression — of  a  large 
proportion  of  such  cases  without  danger,  has  been  verified  in  all  por- 
tions of  the  civilized  world,  many  operators,  including  the  author, 
going  even  farther  than  he  originally  claimed  in  reporting  actual 
anatomical  disappearance  of  some  growths  under  their  care.  The 
inevitable  result  of  such  an  announcement  has  been  intensified  by 
the  fact  that  it  was  made  at  a  time  when  the  early  triumphs  of  anti- 


Fig.  37. — Multinuclear  interstitial  fibroid  with  one  nodule  affecteu  by 

calcareous   degeneration.      (From   specimen    in    the    Mutter 

Museum  of  the  College  of  Physicians.) 


sepsis  were  inviting  surgeons  to  added  daring  in  abdominal  operations, 
and  hence  a  most  powerful  and  influential  opposition  was  aroused. 
Some  surgeons,  it  is  true,  took  it  up  without  sufficient  preliminary 
training  to  make  a  success  of  it,  and  others  after  adopting  it  have 
frankly  confessed  that  it  hurt  their  more  remunerative  surgical  repu- 
tations; but  it  remains  a  fact  that  no  single  person  who  investi- 
gated the  subject  in  a  truly  scientific  spirit  has  seen  fit  to  reject  it  as 
a  most  valuable  addition  to  the  resources  of  the  curative  art.  The 
recent  history  of  this  subject  has  reached  such  enormous  dimensions 


FIBROID   TUMORS.  129 

that  even  a  cursory  review  would  be  out  of  place  in  pages  devoted  to 
the  practical  side  of  the  work,  and  I  may  merely  add  that  we  are  in- 
debted most  particularly  to  the  late  Dr.  Thomas  Keith,  of  London, 
formerly  of  Edinburgh,  the  first  and  most  eminent  surgeon  to  suc- 
cessfully remove  large  numbers  of  fibroid  tumors  with  the  knife,  for 
a  most  effective  plea  in  favor  of  a  trial  of  the  Apostoli  treatment  before 
the  performance  of  any  more  bloody  operations  with  the  knife,  and 
who,  in  collaboration  with  Dr.  Skene  Keith,  published  a  work^  con- 
taining the  details  of  106  cases  so  treated.  In  the  introduction  to 
this  work  these  justly  eminent  surgeons  say:  "For  long  we  had 
doubts  as  to  the  permanency  of  the  treatment  in  the  early  cases. 
The  later  work  has  been  much  more  satisfactory.  But  now  more 
than  two  years  have  passed  since  all  operations  were  given  up  for 
this  treatment;  and  our  first  patient  writes — and  no  one  could 
have  had  more  hemorrhage — that  she  has  been  perfectly  well  all 
summer,  climbing  hills  and  rowing  in  a  boat.  Another  of  the  early 
and  doubtful  ones,  who  could  never  bear  a  large  dose  of  electricity, 
tells  us:  'I  am  now  in  excellent  health,  without  an  ache  or  pain  of 
any  kind,  and  my  periods  are  just  a  show,  and  nothing  more,  and  give 
me  no  discomfort  whatever.  I  hope  you  have  been  as  successful  with 
all  your  other  patients  as  you  have  been  with  me.  But  it  cannot  be 
otherwise,  for  I  am  sure  that  no  one  could  have  been  worse  than  I 
was  with  that  awful  hemorrhage.'  This  patient's  importunity  had 
almost  driven  me  into  doing  hysterectomy  for  her. 

"At  first  we  fell  into  the  natural  mistake  of  trying  electricity  on 
every  case  that  presented  any  symptoms, — in  some  when  the  tumors 
were  almost  certainly  sarcomatous,  and  even  in  one  who  was  in  the 
last  stages  of  old  cardiac  disease.  We  know  now  that  the  cases  best 
treated  are  those  who  are  suffering  much  from  hemorrhage, — the 
more,  the  better, — cases  in  which  something  must  be  done;  cases  in 
which,  two  or  three  years  ago,  the  question  of  operation  of  some  kind 
would  have  been  considered  by  us. 

"This  treatment,  it  must  be  remembered,  is  a  new  thing.  We 
began  it  in  comparative  ignorance.  Electricity  is  known  by  its  results, 
and,  working  on  the  living  body,  progress  and  improvement  are  slow. 


^  "Electricity  in  the  Treatment  of  Uterine  Tumors,  being  Part  II  of  Con- 
tributions to  the  Surgical  Treatment  of  Tumors  of  the  Abdomen,"  by  Thomas 
and  Skene  Keith,  pages  255  et  seq.    Edinburgh:    Oliver  &  Boyd,  1889. 

9 


130  DISEASES    OF    WOMEN. 

In  the  following  cases,  therefore,  are  found  some  faihires  and  some 
imperfect  and  incomplete  cases;  the  marvel  is  rather  that  there  are  so 
few.  Time  and  experience  every  day  correct  our  want  of  knowledge 
and  diminish  these  imperfections.  No  large  uterine  tumor  has,  with 
us,  entirely  disappeared  under  the  electric  treatment,  but  in  four  cases 
of  small  fibroids,  three  of  which  come  into  the  present  series,  there 
is  not  now  a  trace  to  be  found. 

"The  carrying  out  of  this  treatment  faithfully  to  the  end  is  not 
an  easy  matter,  and  old  tumors  that  are  large,  and  that  have  bled  for 
many  years,  take  a  long  time  to  improve.  The  treatment  runs  away 
with  time,  and  it  requires  care  and  thought.  To  the  surgeon,  by  far 
the  simpler  plan  is  hysterectomy  and  the  removal  of  the  ovaries.  But 
Dr.  Apostoli's  treatment  saves  our  patient  from  risk  of  life  by  opera- 
tion, and  saves  them  also  from  a  horrid  mutilation, — the  one  thing 
that  they  all  dread.  We  believe  it  to  be  the  right  treatment,  and  our 
patients  must  get  it,  however  great  the  inconvenience  and  monotony 
it  may  be  to  ourselves.  Though  our  results  after  hysterectomy  show 
the  lowest  mortality  of  any  yet  recorded,  and  though  we  have  had  but 
a  single  death  after  removal  of  the  ovaries  for  fibroid  in  almost  one 
hundred  operations,  we  reject  even  the  minor  operation  in  favor  of 
Dr.  Apostoli's  treatment,  and  we  reject  hysterectomy  altogether  on 
account  of  the  mortality  that  has  hitherto  attended  it  all  over  the 
world.  The  method  given  us  by  Dr.  Apostoli  is  good,  and  it  will 
endure." 

In  dedicating  this  work  to  Apostoli,  the  elder  Dr.  Keith,  who 
has  since  passed  to  the  great  majority,  leaving  with  us  an  ever-living 
memory  of  unsurpassed  skill,  exalted  courage,  and  unflinching  hon- 
esty, makes  some  additional  statements  which  might  be  taken  as  a 
final  testament  of  a  long  and  honored  career  concerning  this  matter:— 

"Since  we  began  your  treatment,  now  more  than  two  years  ago, 
we  have  ceased  to  perform  any  operation  on  the  uterus  by  abdominal 
section.  For  myself,  I  have  always  had  grave  doubts  if  I  were  justified 
in  performing  such  operations  at  all,  especially  hysterectomy,  for  the 
mortality  attending  this  operation  is  out  of  all  proportion  to  the 
benefits  received  by  the  few.  As  time  went  on,  and  the  number  of 
operations  became  larger,  my  doubts  as  to  whether  I  were  doing  right 
continued  to  increase,  and  that,  too,  in  spite  of  the  comparatively  low 
mortality  with  which  I  was  favored,  more  especially  in  my  private 
practice.    I  never  had  any  such  doubts  as  to  the  propriety  of  perform- 


FIBIWID    TUMOKS.  131 

ing  ovariotomy,  for,  if  ovarian  cysts  be  left  alone,  death  is  almost 
certain,  and  even  that  is  only  reached  after  great  suffering.  With 
hysterectomy  it  is  quite  different.  Hysterectomy  is  a  hazardous  oper- 
ation for  the  removal  of  a  tumor  that,  of  itself,  rarely  shortens  life. 
The  minor  operation,  on  the  other  hand, — the  removal  of  the  ovaries, 
— requires  no  surgical  skill  for  its  performance.  It  is  a  great  mutila- 
tion to  a  woman,  being  simply  castration;  and  women  are  beginning 
to  find  this  out.  It  is  not  always  successful  in  attaining  its  purpose, 
for  you  will  find  in  these  pages  some  cases  narrated  that  were  cured 
by  electricity  where  operations  on  the  ovaries  had  failed  to  give  any 
relief. 

"Your  method  thus  came  to  me  at  a  very  opportune  time.  You 
have  taken  away  from  me  those  anxious  doubts  and  fears  that  had 
so  long  vexed  me.  For  long  I  had  hoped  much  from  electricity  in 
the  treatment  of  fibroids,  but  had  only  met  with  disappointment  till 
your  method  was  made  known  to  me.  It  is  in  every  way  a  new  method, 
and  it  belongs  to  you  and  to  no  other.  You  have  worked  in  the  true 
scientific  spirit.  For  five  years  you  labored  quietly  at  your  clinic, 
kept  up  at  your  ow^n  expense,  and  open  to  all,  before  you  made  your 
work  known.  When  it  was  made  public,  and  ought  to  have  had  from 
all  a  warm  welcome,  or  at  least  a  patient  hearing  and  honest  investi- 
gation, considering  the  magnitude  of  your  work,  it  was  received  with 
unbelief  and  ridicule.  In  common  with  many,  I  regret  the  unfair 
treatment  you  have  received  in  this  country.  In  spite,  however,  of 
the  ignorance  and  prejudice  displayed,  your  work  is  every  day  making 
its  way,  and  it  is  impossible  to  resist  the  accumulating  evidence  there 
now  is  in  its  favor.  That  you  will,  in  a  few  years,  see  your  treatment 
adopted  all  over  the  world  I  have  little  doubt." 

The  prophecy  contained  in  the  last  sentence,  quoted  from  Dr. 
Keith's  work,  has  long  since  been  fulfilled. 

Mode  of  Action  of  Electricity. — Much  misconception  has  existed 
as  to  the  mode  in  which  electricity  is  expected  to  act  in  these  tumors, 
the  original  impression  with  many,  uncorrected  in  the  previous  edi- 
tions of  this  work,  being  that  the  purpose  of  the  applications  was  the 
physical,  electro-chemic  decomposition  of  the  tumor-substance.  This, 
of  course,  can  be  done  wdth  a  sufficient  current-volume,  but  it  would 
be  followed  by  the  formation  of  a  sloughing  mass  of  dead  tissue  sur- 
rounding the  electrodes  that  would  be  dangerous  in  tumors  situated 
within  the  body,  as  these  are.    Wliat  does  happen  as  a  result  of  the  use 


132  DISEASES    OF    ^VOJIEK. 

of  currents  of  far  less  volume  and  duration  is  a  shrinkage  of  the  tumor 
en  masse,  no  greater  shrinkage  occurring  in  the  parts  nearest  the  spe- 
cial seat  of  application  or  puncture  than  in  those  situated  most  dis- 
tant. It  appears,  therefore,  that  the  nature  of  the  response  is  essen- 
tially trophic,  the  passage  of  currents  of  sufficient  volume  through  the 
tumor  causing  an  inhibition  of  the  proliferating  power  of  its  abnormal 
cells,  followed  by  a  retrograde  metamorphosis,  quickened  tissue-waste, 
and  absorption  through  the  lymphatics  and  veins,  particularly  the 
former,  with  which  these  growths  are  abundantly  supplied.  Coin- 
cidently  with  this  direct  action  upon  the  lowly  organized  embryonic 
tissue  of  the  tumor,  it  is  certain  that  an  increased  physiologic  resist- 
ance of  the  healthy  surrounding  tissues  (trophic  stimulation)  is  pro- 
moted by  the  passage  of  the  electric  current,  and,  as  the  most  plausible 
theory  of  the  growth  of  these  tumors  involves  a  lessening  of  this  re- 
sisting force  as  a  primal  cause,  its  stimulation  must  be  essential  to 
a  curs. 

It  will  be  seen  that  the  essence  of  this  discovery  of  Apostoli  is 
that  electricity  may  be  used  to  arouse  the  natural  forces  of  the  body 
to  remedy  a  faulty  cellular  growth  by  simply  reversing  the  conditions 
that  made  the  growth  possible.  The  absorptive  powers  of  the  tissues 
are  well  known,  even  unstimulated  by  electricity, — bone,  cartilage, 
and  tumor  tissues  aseptically  buried  in  the  flesh  being  readily  dis- 
integrated and  removed;  hence  it  is  clearly  seen  that  the  most  impor- 
tant element  of  the  electric  treatment  is  the  reversal  of  the  formative 
conditions  of  the  neoplasm.  The  task  of  the  physician  is  the  selection 
of  the  cases  in  which  this  can  be  done  and  the  determination  of  the 
dosage  and  methods  requisite  for  each  case. 

The  reduction  in  the  size  that  follows  shortly  after  commencing 
a  treatment  adapted  to  the  special  case  results,  also,  in  a  progressive 
relief  of  the  pain,  tenderness,  and  other  pressure  sjmptoms  due  to 
the  growth.  This  early  relief  of  pain  and  pressure  symptoms  must  be 
parti}'  due  to  the  shrinkage  alone,  the  nerves  and  organs  that  had  been 
stretched  and  pressed  upon  being  capable  of  adapting  themselves  to  a 
still  abnormal  condition  by  reason  of  the  partial  relief  afforded;  but 
much  of  the  s}Tnptomatic  improvement  must  be  due,  also,  to  an  elec- 
tric stimulation  of  the  physiologic  resistance  opposing  the  growth,  as 
evidenced  by  a  lessening  of  any  surrounding  inflammation,  restoration 
of  pelvic  and  abdominal  tone,  and  even  increase  in  the  thickness  of 
the  abdominal  wall. 


FIBROID    TUMORS.  133 

In  addition  to  the  arrest  and  retrogression  of  the  growth  and  the 
relief  of  pressure  and  inflammatory  symptoms,  an  even  more  impor- 
tant and  equally  certain  result  is  the  cure  of  the  hemorrhagic  symp- 
toms that  attend  so  many  of  these  cases.  This  hemorrhagic  tendency, 
which  sometimes  assumes  alarming  proportions,  is  due  to  one  or  both 
of  two  characteristics:  either  a  fungous  endometritis  (adenomatous 
degeneration  of  the  endometrium)  or  to  an  hemorrhagic  tendency  of 
the  tumor  itself.  That  curettage  is  useful  in  correcting  adenomatous 
degeneration  is  unquestionable,  but  it  exerts  no  control  over  what 
might  be  called  the  essential  hemorrhagic  tendency  of  a  fibroid;  hence 
is  far  inferior  to  electricity  as  an  hemostatic  in  such  cases.  The  slowly- 
produced  effect  of  mercurial  eataphoresis  is,  moreover,  more  certainly 
and  permanently  curative  of  the  fungous  condition  even  than  curet- 
tage, by  reason  of  the  more  effectual  eradication  of  the  matrices  of  the 
growth.  To  effect  this  the  electrode  must  be  most  thoroughly  applied 
to  all  portions  of  the  endometrium  by  the  sectional  method  devised 
by  Apostoli,  in  which  a  bulbous  anode  as  large  as  can  be  inserted  is 
carried  to  the  fundus,  and,  after  a  suitable  application  there,  is  with- 
drawn a  distance  equal  to  the  length  of  the  active  surface  and  the 
current  again  turned  on,  the  procedure  being  repeated  until  the  instru- 
ment again  reaches  the  internal  os  on  the  way  out.  The  hemostatic 
effect  will  be  heightened  if  the  additionally  alterative  action  of  a  zinc- 
mercury  electrode  is  employed  as  active  pole  instead  of  platinum  or 
carbon.  In  hemorrhagic  tumors  the  action  of  electricity  is,  there- 
fore, dual,  the  local  effect  on  the  endometrium  being  hemostatic  and 
the  inhibition  and  shrinkage  of  the  growth  being  antihemorrhagic. 

Selection  of  Suitable  Cases. — All  fibroid  tumors  in  the  early 
stages  of  their  growth  are  suitable  cases  for  this  treatment,  unless, 
indeed,  where  electric  treatment  in  the  pelvis  is  contra-indicated  by 
reason  of  a  purulent  collection  within  this  cavity.  The  presence  of 
such  a  contra-indication  is,  however,  infallibly  announced  by  an 
aggravation  of  symptoms  after  the  first  few  applications,  and  in  the 
absence  of  this  post-applicative  reaction  it  may  be  confidently  assumed 
that  all  tumors  not  yet  emerged  from  the  pelvis  are  amenable  in  a 
high  degree  to  both  symptomatic  cure  and  anatomic  arrest  and  lessen- 
ing. Of  tumors  so  large  as  to  have  emerged  from  the  pelvis  and  be- 
come abdominal  in  situation  greater  care  in  selection  is  requisite 
before  promising  the  best  results,  for  it  should  be  remembered  that 
neither  Apostoli  nor  other  authoritative  writers  have  claimed  that  all 


134  DISEASES    OF    WOMEN. 

cases  are  equally  amenable  to  electricity.  After  they  have  attained 
this  size  the  intramural  variety  is  most  amenable  to  both  amelioration 
and  cure,  though  there  are  a  certain  number  of  smooth,  monocentric 
fibromas  of  ball-like  contour  and  firm  texture  that  yield  very  slowly 
to  anatomic  change,  even  though  tiiey  may  be  classed  as  interstitial 
or  intramural  because  of  a  distinct  situation  within  the  uterine  wall. 
In  most  of  these  slowly-responding  tumors  of  this  character  the  uter- 
ine cavity  is  found  stretched  upon  one  side  of  the  growth,  the  opposite 
wall  being  attenuated.  "When  the  cavity  is  more  nearly  central,  and 
there  are  evidences  of  several  foci  of  growth  giving  rise  to  a  multi- 
nodular surface,  the  case  is  a  most  favorable  one  for  marked  diminu- 
tion as  well  as  symptomatic  cure. 

Distinctly  submucous  tumors  are  also  suitable  cases,  the  current 
arousing  the  contractile  action  of  the  encompassing  muscular  fibres 
as  a  re-enforcement  of  the  special  denutritive  effect,  and  such  tumors 
are  thus  brought  further  into  the  uterine  cavity,  becoming  more 
pedunculated. 

Subperitoneal  tumors,  particularly  when  pedunculated,  are  not 
easily  reached  by  effective  applications  unless  imprisoned  in  Doug- 
las's pouch,  when  they  may  be  brought  under  the  electric  influence 
by  vaginal  puncture  through  the  median  line  of  the  posterior  wall 
of  the  vagina.  "V\Tien  a  subperitoneal  tumor  is  very  large  and  abdomi- 
nal in  situation,  and  lying  directly  beneath  the  abdominal  wall,  ab- 
dominal puncture  by  the  method  described  on  page  138  may  be  used. 

Centra-indications. — Fibrocystic  tumors,  or  unusually  soft  myo- 
mas,  contra-indicate  the  intra-uterine  and  puncture  methods,  and  the 
same  is  true  of  all  fibroids  complicated  with  acute  oi  purulent  lesions 
within  the  pelvis  or  with  abdominal  ascites.  Xon-purulent  inflam- 
matory troubles  in  this  region  also  contra-indicate  both  of  these 
methods  at  first,  but  do  not  contra-indicate  vaginal  treatment,  under 
which  they  may  so  far  improve  as  to  make  the  more  vigorous  methods 
subsequently  admissible.  A  successful  case  of  destructive  electrolysis 
of  an  intra-uterine  fibrocyst  is  described  on  page  158,  but  the  method 
employed  was  totally  distinct  from  the  Apostoli  treatment,  and  the 
excellent  result  attained  does  not,  therefore,  controvert  these  conclu- 
sions. Unless  we  are  in  a  position  to  dissolve  and  drain  away  the 
fibrocyst  under  full  antiseptic  precautions,  as  was  possible  in  this 
case,  the  ordinary  effect  of  electricity  in  promoting  tissue-change  is 
detrimental  in  the  presence  of  the  clogged  lymph-spaces  and  deficient 
lymphatic  circulation  that  is  peculiar  to  this  form  of  degeneration. 


FIBEOID    TUMORS.  135 

Methods. — Bearing  in  mind,  on  the  one  hand,  that  the  current 
should  be  concentrated  as  near  as  possible  to  the  matrix  of  the  tumor, 
and,  on  the  other,  that  it  is  not  always  necessary  to  produce  a  lesion 
of  the  mucous  membrane  in  an  inaccessible  locality,  it  follows  that 
the  best  methods  in  the  majority  of  cases  are:  either  intra-uterine 
applications  with  as  large  an  active  surface  within  the  uterus  as  can 
be  inserted,  or  vaginal  puncture.  It  has  not  been  my  experience  that 
vaginal  puncture  offers  any  quicker  results  than  the  intra-uterine 
treatment  in  interstitial  or  intramural  tumors  with  accessible  cavities, 
and  I  reserve  it,  therefore,  for  cases  in  which  the  intra-uterine  treat- 
ment is  impracticable  or  is  clearly  inefficient  by  reason  of  the  growth 
being  subperitoneal. 

Intra-uterine  Applications. — The  intra-uterine  method  is  there- 
fore the  method  of  choice  in  most  cases,  both  for  theoretic  and  em- 
pirical reasons,  and  is  the  method  particularly  associated  with  the 
name  of  Apostoli.  Its  employment  for  fibroids  does  not  differ  in 
technique  from  that  described  on  page  59,  to  which  the  reader  is 
referred,  the  special  directions  for  the  treatment  of  hemorrhagic  cases 
being  given  on  page  84.  An  important  detail  to  be  observed  is  to 
employ  as  large  an  instrument  as  can  be  inserted,  in  order  that  the 
local  action  shall  be  equally  applied  to  the  cavity.  In  many  cases  we 
are  compelled  to  rely  on  the  rigid  sound-shaped  electrode  (Fig.  24), 
because  nothing  else  can  be  inserted.  This  instrument,  like  all  others 
used,  should  be  properly  curved,  asepticized,  and  the  insulation^ 
renewed  and  carefully  inspected  before  each  insertion,  the  shellac  or 
sealing-wax  being  carried  down  to  a  point  that  will  bring  the  bare 
surface  entirely  within  the  internal  os  to  avoid  the  formation  of  late 
atresias.  Whenever  it  can  be  inserted  I,  however,  prefer  to  employ 
the  cotton-covered  elastic  platinum  electrode  (Fig.  25),  or  in  hemor- 
rhagic or  endometritic  cases  a  suitable  size  of  the  zinc-amalgam  elec- 
trode (Fig.  26),  as  positive  pole,  for  recent  experience  has  aroused 
a  strong  suspicion  that  the  nascent  oxychloride  of  mercury  and  zinc 
is  of  additional  service  in  promoting  arrest  and  absorption  of  the 
growth.  When  employed  it  should  be  freshly  amalgamated  previous 
to  each  application,  to  favor  as  great  a  dissemination  of  the  mercury 
as  possible.    This  necessitates  the  invariable  employment  of  the  posi- 


'  Shellac  or  sealing-wax  fused  on  the  shaft. 


136 


DISEASES    OF    WOMEN. 


tive  pole/  even  in  non-liemorrhagic  cases,  it  is  true,  but  the  denu- 
tritive  effect  is  certainly  greater  than  with  the  simple  negative  pole, 
besides  the  comfort  to  the  physician  of  the  knowledge  that  he  is 
employing  a  most  powerful  antiseptic  agency  coincidently  with  the 
arresting  treatment  per  se. 

Vaginal  Puncture. — Eeserved  for  subperitoneal  tumors  of  pelvic 
situation,  or  interstitial  growths  with  inaccessible  cavities,  this  method 


—  ■MtT—"hiii-'- ■'-"•'■- 

Fig.  38. — Apostoli"s  vaginal  puncture  trocar,  for  use  with  handle 
shown  in  Fig.  23. 

should  only  be  employed  through  the  posterior  vault  of  the  vagina 
owing  to  the  near  situation  of  important  structures  in  other  portions 
of  the  pelvis.  Apostoli  originally  employed  for  this  purpose  a  large 
trocar  with  a  shoulder  limiting  its  insertion  to  either  a  half  or  one 
centimetre,  the  vagina  being  protected  by  a  movable  sheath  of  hard 
rubber  or  glass;  but  since  1892,  possibly  owing  to  the  author's  advo- 
cacy of  a  completely-insulated  puncture-track,  or  buried  puncture,  in 


Vy',MjJJM.>JM/,JMuM^^//y'W^/M//">!-M^^^ 


Z 


>//y>yy>yy;/yA'.-'AVV///Y^^^/A 


-"  "  Vi"  i^i'i'  f^J^7///;/  y//,v/£c 


3 


miMJfIinmmimM)iM)miimmmmimnmiiiihi,,hi,>ii),niimiihii,M,ii)i!ii/rTrT. 


Fig.  39. — Author's  vaginal  puncture  trocar   (enlarged  sectional  view), 


the  earlier  editions  of  this  work,  he  employs  the  trocar  shown  in  Fig. 
38,  with  the  sheath  and  handle  shown  in  Fig.  23.  The  latest  model 
of  the  author  is  shown  in  Fig.  39,  in  which  the  limiting  shoulder  of 
Apostoli  is  added,  but  the  insulation  is  fused  freshly  for  each  applica- 
tion on  the  shank  of  the  trocar  itself,  doing  away  with  both  the  tube 
and  the  awkward  edge  of  insulation,  which  hinders  easy  insertion,  and 


*  This  instrument  may,  of  course,  be  employed  as  a  negative  electrode  if 
desired;    but  no  diffusion  by  cataphoresis  then  occurs. 


FIBROID    TUMORS.  137 

securing  absolute  asepsis.  As  the  author  invariably  employs  the  nega- 
tive pole,  the  instrument  is  preferably  made  of  steel. 

The  insulation  is  of  hard  rubber,  a  stick  of  which  is  set  on  fire 
and  applied  to  the  heated  instrument  while  burning,  the  coating  being 
then  re-fused  and  made  smooth  in  that  way.  When  done  carefully, 
the  coating  is  continuous  back  of  the  bare  surface  at  the  point,  the 
small  shank  in  front  of  the  shoulder  being  brought  up  to  the  diameter 
of  the  point  by  its  thin  coating,  which  continues  back  over  the 
shoulder  on  to  the  main  shank  without  break. 

The  instrument  being  thus  freshly  asepticized,  as  well  as  insu- 
lated, the  vagina  is  douched  with  a  bichloride  or  other  antiseptic 
solution,  and  with  the  patient  in  the  dorsal  position,  the  hips  resting 
on  a  firm  table  or  operating-chair,  the  instrument  is  inserted  with 
the  point  resting  in  the  palmar  surface  of  the  index  finger,  thus 
shielding  the  vagina.  Eeaching  the  projecting  portion  of  the  tumor 
at  a  spot  previously  determined  on,  the  point  is  carried  forward  and 
pressed  firmly  into  it  through  the  vaginal  wall,  an  assistant  mean- 
while steadying  the  tumor  from  above.  When  the  full  insertion  is 
made  and  the  abdominal  pad  placed  the  current  is  turned  on  until 
it  registers  between  100  and  200  milliamperes,  negative.  The  dura- 
tion of  the  application  is  the  same  as  within  the  uterus. 

The  act  of  puncturing  the  vagina  gives  rise  to  considerable  pain, 
but  most  women  are  easily  able  to  bear  it,  and  the  subsequent  action 
of  the  current  is  no  more  painful  than  in  the  intra-uterine  applica- 
tions, if  the  active  surface  of  the  electrode  is  carried  well  beyond  the 
mucous  membrane.  Some  of  my  punctures  have  been  made  under 
anesthesia,  but  I  prefer  to  do  without  general  anesthetics,  when  prac- 
ticable, on  account  of  full  anesthesia  being  necessary  to  obviate  the 
troublesome  movements  of  a  partially  anesthetized  person.  While 
withdrawing  the  instrument  the  finger  should  be  pressed  against  the 
vaginal  wall  alongside  of  it  as  a  support,  the  insulated  portion  having 
a  tendency  to  stick  fast.  Antiseptic  douches  will  usually  be  the  only 
after-treatment  required,  in  addition  to  rest  and  hot  applications  for 
the  relief  of  pain,  should  it  appear.  In  case  the  puncture  is  made  in 
the  physician's  office  the  patient  should  be  sent  home  in  a  carriage. 

These  punctures  may  be  made  as  frequently  as  three  times  a 
month.  I  have  myself  made  them  twice  a  week  for  a  time,  a  slightly 
different  spot  being  selected  on  each  occasion;  but  when  employed  so 
frequently  the  physician  should  be  on  the  lookout  for  a  local  reaction. 


138  DISEASES    OF    WOMEN. 

which  should  be  the  sign  for  a  cessation  of  the  treatment  until  it  has 
subsided. 

Buried  vaginal  puncture  will  reduce  fibroids  and  remove  pain 
when  the  intra-uterine  method  is  not  tolerated.  I  have,  moreover, 
never  had  a  mishap  or  bad  effect  from  its  use,  though  this  may  be 
attributable  to  a  careful  selection  of  cases,  as  I  can  well  conceive  that 
the  procedure  might  result  in  injury  to  important  organs  if  employed 
in  any  case  other  than  those  in  which  the  tumor  is  accessible  by  virtue 
of  a  practical  protrusion  into  the  posterior  vaginal  vault. 

Abdominal  Puncture. — Where  the  tumor  is  so  large  as  to  be 
abdominal  in  situation  and  not  readily  reached  through  the  cervical 
canal  or  by  vaginal  puncture  I  have  found  it  expedient  to  puncture 
through  the  abdominal  wall  by  a  method  that  I  devised  and 
described  lefore  the  American  Electro-Therapeutic  Association  before 
learning  that  the  late  Dr.  Freeman,  of  Brooklyn,  had  employed  a 
somewhat  similar  method  in  a  cruder  form.  The  fact  that  Dr.  Free- 
man never  published  anything  relating  to  his  work  had  left  the  sub- 
ject of  abdominal  puncture  of  fibroids  represented  in  literature  only 
by  the  exceedingly  crude  and  unscientific  work  of  the  early  '70's, 
when  uninsulated  electrodes  resembling  bayonets  were  used,  with 
which  the  unfortunate  patients  were  transfixed.  To  the  bayonets 
was  attached  a  batter}'  consisting  of  a  single  cell.  The  infinitesimal 
current  that  was  used  in  this  harsh  method,  coupled  with  the  fact 
that  the  work  was  done  in  the  preantiseptic  times,  caused  a  mortality 
altogether  out  of  proportion  to  any  good  results,  and  has  given  a  bad 
name  to  abdominal  puncture  that  is  totally  undeserved.  These  tumors 
are  beneath  our  hands  when  they  have  risen  entirely  into  the  abdo- 
men, with  only  the  abdominal  wall  and  two  layers  of  peritoneum 
intervening.  As  contrasted  with  the  pelvic  route,  scientific  pimcture 
from  this  direction  is  free  from  the  embarrassing  neighborhood  of 
important  organs  if  no  intestines  are  in  the  way,  is  direct  and  exact, 
but  possesses  the  one  disadvantage  of  being  intraperitoneal.  By  the 
expedient  of  employing  only  insulated  electrodes  to  protect  all  tissues 
above  the  tumor  the  two  pricks  made  by  the  needle  in  the  peritoneum 
heal  immediately,  and  in  several  hundred  punctures  made  by  me 
by  the  method  described  below  there  has  not  been  a  single  instance 
of  untoward  results  of  any  kind,  and  no  evidence  that  any  puncture 
resulted  in  adhesions. 

The  details  of  the  procedure  as  devised  by  the  author  are  as  fol- 


FIBHOID    TUMOKS.  139 

low:  The  punctures  being  invariably  negative,  small  steel  needles  are 
used,  three  at  each  puncture,  attached  by  branch  wires  to  a  single 
pliant  copper  wire  as  a  conducting  cord  (Fig.  40).  No.  22  or  24  in- 
sulated wire  is  much  more  convenient  than  an  ordinary  conducting 
cord.  For  the  puncture  needles  there  can  be  no  better  form  devised 
than  the  straight  Hagedorn  surgical  needle  found  in  every  instru- 
ment-shop. These  needles  possess  the  advantage  of  great  ease  of  pene- 
tration, combined  with  lightness  and  strength,  and  the  slit  puncture 
made  by  them  admits  the  increased  bulk  of  the  covering  without 
hitch.  This  slit  form  of  puncture  also  heals  easily  without  a  scar. 
The  needle  should  be  about  three  inches  long,  the  first  half-inch  from 
the  point  being  left  bare  and  the  remaining  portion  covered  with  hard 
rubber  vulcanized  on  the  shank  as  thinly  as  consistent  with  good 
insulation.^  It  is  easily  attached  to  the  copper  wire  by  the  latter 
being  passed  through  the  eye  and  wound  around  the  shank  in  contact 


Fig.  40. — Author's  abdominal  puncture  needle  (shown  in  enlarged  section). 

with  the  metal.  With  the  patient  lying  upon  a  large  pad  attached 
to  the  positive  pole,  these  needles,  properly  insulated,  sterilized,  and 
attached  to  the  negative  pole  of  the  battery  by  the  branched  wire, 
are  easily  and  painlessly  thrust  into  the  tumor  through  the  skin,  the 
surface  having  been  previously  rendered  surgically  clean.  Just  before 
the  insertion  of  each  needle  the  spot  selected  should  be  anesthetized 
by  a  chloride-of-ethyl  or  rhigolene  spray.  The  current-strength  has 
varied  in  my  punctures  between  60  and  200  milliamperes,  and  the 
duration  from  six  to  eight  minutes.  After  the  removal  of  the  needles 
the  minute  spots  made  are  sealed  by  the  application  of  collodion.  As 
to  frequency,  it  is  probably  best  to  allow  at  least  one  or  two  weeks 
to   elapse  between  each  application  of  electricity  in  this  manner. 


^  The  insulation  and  reinsulation  should  be  done  before  each  puncture, 
by  the  physician  himself,  to  insure  asepsis  from  heat  and  soundness  of  the  cov- 
ering. Melted  hard  rubber  from  an  old  thermometer-case  set  on  fire  will  ad- 
here to  the  needle  if  the  latter  is  heated. 


140  DISEASES    OF    WOMEN. 

although  this  "depends  on  the  size  of  the  tumor  and  the  field  of  tumor- 
surface  accessible  to  the  method.  It  need  scarcely  be  said  that  no 
punctures  should  be  made  at  any  spot  that  might  be  covered  by  intes- 
tinal convolutions. 

The  immediate  inconveniences  that  follow  these  punctures,  such 
as  tenderness  and  pain,  are  generally  less  than  those  following  an 
intra-uterine  application.  As  a  measure  of  precaution,  some  patients 
under  this  treatment  have  been  kept  in  bed  in  the  sanatorium  or  hos- 
pital for  twenty-four  hours  after  each  puncture,  but  others  have  been 
punctured  at  the  hospital  or  clinic  and  walked  home  shortly  afterward. 

Vagijio-Ahdominal  Applications. — Danion,  a  former  pupil  of 
Apostoli,  has  made  the  claim  that  mere  vagino-abdominal  alternatives 
are  both  sufficient  and  superior  to  the  intra-uterine  and  puncture 
methods  in  the  treatment  of  fibroids.  This  is  unquestionably  a  mis- 
take as  a  broad  claim,  for  the  greater  resistance  of  the  tumor-tissue 
compels  the  bulk  of  the  current  to  pass  around  it  when  the  active 
electrode  is  not  within  its  substance.  That  this  method  may  act  effect- 
ively upon  some  tumors  is  nevertheless  certain,  and  the  author  had, 
in  fact,  used  it  long  before  the  claims  of  Danion  came  to  his  attention. 
It  is  indicated  as  the  proper  treatment  whenever  the  more  active 
methods  are  for  any  reason  inexpedient  or  contra-indicated,  as  when 
there  is  more  tenderness  in  the  ovarian  regions  than  would  render 
intra-uterine  treatment  wise;  when  periuterine  congestion  or  an  old 
pelvic  peritonitis  with  adhesions  overshadow  the  tumor  in  the  pro- 
duction of  symptoms;  or  when  the  patient  is  so  advanced  in  years  or 
so  feeble  as  to  render  more  active  treatment  unwise.  It  may  be  also 
used  with  advantage  in  the  intervals  between  the  days  of  more  active 
treatment. 

In  employing  the  alternatives  the  ordinary  vagino-abdominal 
method  is  varied  by  leaving  the  electrodes  in  situ  after  turning  the 
current  off,  reversing  the  polarity  at  the  commutator,  and  then  turn- 
ing the  current  on  again  in  the  same  gradual  manner,  repeating  the 
procedure  a  number  of  times  with  a  current-duration  each  time  of 
about  a  minute.  The  advantages  of  this  method  are:  greater  con- 
traction of  muscular  fibre  by  reason  of  the  variation  of  potential  being 
exactly  double  what  it  would  be  with  the  same  current-strength  with- 
out reversal,  and  a  protection  of  the  vagina  from  erosion,  since  the 
electrolytic  action  is  nullified  in  each  reversal.  Its  disadvantage  com- 
pared with  simple  vagino-abdominal  applications,  which  are,  at  times. 


FIBROID    TUMOltS.  141 

preferable,  is  that  the  actions  of  electrolysis  or  cataphoresis  are  prac- 
tically wanting. 

Results  of  Treatment  by  Electricity. — A  method  designed  for 
the  relief  of  human  ailments  must  stand  or  fall  on  its  ascertained 
results  alone,  no  matter  how  plausible  may  be  the  theory  or  hypothesis 
on  which  it  is  founded  or  explained.  Tested  by  this  rule,  electricity 
in  the  treatment  of  fibroids  has  more  than  fulfilled  the  modest  claims 
of  Apostoli,  for  a  much  larger  proportion  of  cases  has  been  completely 
removed  by  absorption  than  was  at  one  time  thought  possible,  the 
extent  of  the  original  claims  being  merely  a  symtomatic  cure  and 
anatomic  regression.  Adhering  to  the  rule  of  personal  experience 
adopted  in  previous  editions  of  this  work,  a  tabulated  list  of  eighty- 
six  cases  of ^  fibromyomata  of  the  uterus  consecutively  treated  is  given 
in  Appendix  A,  the  results  in  many  of  which  are  stated  at  periods 
varying  from  two  to  ten  years  after  the  cessation  of  treatment.  On 
analyzing  this  table  the  following  results  appear: — 

Cases  resulting  in  anatomic  and  symptomatic  cure: 

(a)  Destroyed  piecemeal  by  electrolysis  through  cervix.    1 

(h)  Extruded  through  cervix  in  whole  or  part 4 

(c)  Disappeared  by  absorption 13 

Cases  resulting  in  symptomatic  cure: 

(a)  With  great  reduction  in  size 16 

(&)  With  slight  reduction  in  size 21 

(c)  Without  change  in  size 10 


Total  cases  resulting  in  practical  success 64 

Symptomatic  improvement  only 4 

Failure  to  effect  any  change 6 

Made  worse 1 

Total  cases  resulting  in  failure  to  relieve 11 

Ultimate  results  unknown 11 


Total  cases 86 

In  computing  the  percentages  of  these  results  it  is  but  just  that 
the  eleven  cases  in  which  the  ultimate  results  are  unknown  should  be 
eliminated  from  consideration  on  account  of  the  fact  that  these  cases 


142  DISEASES    OF    WOMEX. 

were  all  dispensary  patients  who  received  but  little  treatment,  it  being, 
in  the  absence  of  definite  information,  as  likel}'  that  this  little  re- 
lieved their  pains  and  thus  caused  them  to  be  careless  about  return- 
ing as  that  the  results  were  only  negative.  Deducting  these  leaves 
seventy-five  cases  in  which,  the  results  are  sufficiently  definite  for 
statistical  purposes. 

The  sixty-four  successful  cases  give,  therefore,  a  percentage  of 
85.33  per  cent,  of  successes,  and  the  eleven  cases  of  but  slight  improve- 
ment, or  no  improvement,  give  a  percentage  of  14.66  of  failures. 

The  one  case  that  was  made  worse  was  a  cystic  intra-uterine 
growth  that  was  improperly  treated  by  electricity  very  early  in  the 
history  of  this  method  and  before  it  was  generally  known  that  such 
cases  should  not  be  treated  by  the  now  classic  intra-uterine  method. 
Future  statistics  will  naturally  be  clear  of  this  source  of  error,  as  well 
as  those  arising  in  attempts  to  favorably  affect  subperitoneal  tumors 
that  are  inaccessible  to  direct  applications.  And,  even  if  no  improve- 
ment be  made  in  these  figures  in  the  near  future,  it  is  a  distinct  satis- 
faction to  the  conservative  physician  to  reflect  that  in  the  15  per 
cent,  of  cases  in  which  electricity  does  no  good  it  can  be  relied  on  to 
do  no  harm  in  proper  hands,  leaving  the  tumors  unchanged  for  the 
trial  of  other  methods.  The  slight  responsibility  in  advising  electric 
treatment  is  evident. 

On  the  other  hand,  the  question  is  a  far  different  one  when  ttie 
surgical  removal  of  these  growths  is  considered.  With  a  mortality  of 
one  in  four  in  the  most  skilled  hands^  the  physician  assumes  a  serious 
responsibility  who  advises  a  resort  to  this  method  before  the  value  of 
electricity  has  been  tested  in  the  case.-  There  is  no  appeal  from  sur- 
gical failure.    It  should  be  the  court  of  last  resort. 

And,  while  lack  of  space  forbids  a  complete  discussion  of  the 
relative  disadvantage  of  other  methods,  it  may  be  said  that  a  marked 


•  Pozzi  (  'Clinical  and  Operative  GjTiecology,"  American  translation,  vol- 
ume i,  page  310)  gives  a  percentage  of  25.80  of  deaths  in  a  list  of  345  opera- 
tions in  the  most  skilled  hands. 

*  A  distinguished  surgeon,  now  deceased,  advised  an  operation  in  one  of 
the  author's  cases.  On  being  appealed  to  whether  he  would  not  have  electricity 
tried  if  she,  the  patient,  were  his  daughter,  he  at  once  assented  and  referred 
her  to  the  writer,  who  has  had  other  evidences  that  a  higher  conception  of 
advisory  responsibility  prevails  among  physicians  when  members  of  their  own 
families  are  involved. 


FIBROID    TUMORS.  143 

contrast  exists  also  between  the  cases  successfully  treated  by  electricity 
and  surgery.  Successful  removal  of  the  tumor  necessitates  removal  of 
the  ovaries  also,  thus  destroying  the  distinctively  feminine  character- 
istics of  the  individual;  produces  a  weak  spot  in  the  abdominal  wall 
leading  to  hernia,  which  is  practically  far  worse  a  tumor  than  the 
original  fibroid;  and  in  some  cases  produces  painful  neuroses  due  to  cut 
nerves,  and  even  at  times  insanity.  No  such  sequences  attend  the 
electric  treatment,  which  invariably  restores  the  patient  to  robust 
health  and  almost  as  invariably  checks  further  growth  of  the  tumor, 
even  in  cases  where  more  or  less  of  the  tumor  remains  after  treatment 
as  a  harmless  lump  of  flesh. 

Fifteen  of  the  cases  contained  in  the  table  deserve  a  report  in 
full, — namely,  the  twelve  cases  that  disappeared  by  absorption;  one 
case  that  is  tabulated  as  extruded  in  part  but  the  bulk  of  which  dis- 
appeared by  absorption;  one  case  treated  by  abdominal  puncture  with 
notable  results;  and  one  case  tabulated  as  destroyed  piecemeal  by  elec- 
trolysis. 

Case  No.  1.^  An  unmarried  lady  of  45,  a  patient  of  the  late  Prof. 
"William  Goodell,  who  had  diagnosed  a  fibroid  tumor  four  years  pre- 
viously, was  admitted  to  my  private  sanatorium  February  11,  1888, 
suffering  from  general  impairment  of  health  due  to  a  tumor  (Fig.  41), 
about  5x3  inches  in  dimensions,  developed  from  the  right  wall  of  the 
uterus,  apparently  in  the  broad  ligament.  As  there  was  a  sharp  turn 
in  the  upper  portion  of  the  uterine  cavity  it  was  thought  at  first  that 
the  tumor  was  broadly  pedunculated,  but  subsequent  exploration  of 
the  cavity  proved  that  it  extended  a  considerable  distance  to  the  right, 
and  that  the  growth  still  formed  the  right  wall  of  the  uterus,  which 
it  had  pressed  very  much  to  the  left.  As  a  downward  prolongation 
of  the  growth  could  be  easily  felt  close  to  the  right  vaginal  wall  it  was 
punctured  in  this  situation  and  150  milliamperes,  negative,  applied. 
This  was  repeated  four  times,  with  a  resulting  diminution  in  the  pro- 
jecting portion  of  the  tumor.  Three  years  subsequently  the  patient 
came  under  observation  again  with  a  continuance  of  menorrhagia  and 
no  reduction  in  the  upper  limit  of  the  growth.  Under  improved  tech- 
nique an  electrode  was  now  passed  four  and  one-fourth  inches  to  the 
fundus  and  a  series  of  positive  intra-uterine  applications  made,  vary- 
ing in  strength  from  30  to  100  milliamperes.  the  tumor  becoming  pro- 


'  The  numbers  refer  to  the  tabulated  list  contained  in  Appendix  A. 


144 


DISEASES    OF    WOMEN. 


gressively  smaller.  The  patient  reports,  recently, — over  ten  years 
after  the  punctures, — that  she  is  unable  to  find  any  sign  of  it  and  is 
in  perfect  health. 


Fig.  41. — Diagram  of  original  outline  of  tumor  in  Case  1. 


Case  No.  5.  A  married  woman  of  38  was  kindly  referred  to  me  for 
electric  treatment  by  Dr.  T.  Hewson  Bradford,  of  Philadelphia,  early 
in  1888,  at  the  Out-Patient  Department  of  the  Pennsylvania  Hospital, 
at  a  time  when  clinical  material  was  very  valuable  in  testing  the  then 


FIBEOID    TUMORS. 


145 


novel  statements  of  Apostoli.  The  growth  consisted  of  a  hard,  irregu- 
lar, multiple  mass  occupying  the  lower  half  of  the  abdominal  cavity, 
a  central  nodule  extending  two  inches  above  the  navel  (Fig.  42).  The 
main  portions  of  the  tumor  lay  to  the  left  of  the  median  line.  The 
OS  was  patulous,  but  lay  so  high  in  the  vault  of  the  vagina  as  to  be 
reached  by  the  finger  with  difficulty.  Menstruation  was  regular,  but 
profuse,  and  attended  with  severe  pain  at  the  beginning  and  end  of 


Fig.  42. — Diagram  of  original  outline  of  tumor  in  Case  5. 


each  period.    Owing  to  pressure,  walking  was  difficult,  and  there  was 
much  swelling  of  the  legs  and  feet. 

The  treatment  was  at  first  by  the  negative  pole,  as  this  was  early 
in  the  application  of  the  method,  with  currents  varying  from  60  to 
150  milliamperes,  resulting  in  some  uncomfortable  sanguineous  flows; 
but  after  five  applications  at  appropriate  intervals  a  distinct  lessening 
of  size  was  noted,  enabling  the  patient  to  wear  dresses  as  much  as  four 
inches  smaller  at  the  waist.    The  improvement  continuing,  the  patient 


146 


DISEASES    OF    WOMEN. 


shortly  after  ceased  treatment  and  took  a  position  as  cook  in  a  large 
family.  Eight  months  later  there  was  a  return  of  pain  and  tenderness 
without  increase  in  size,  and,  as  it  was  desirable  that  rest  should  follow 
each  application,  she  was  admitted  to  the  house  department  of  the 
Howard  Hospital  and  treated  for  six  weeks  wdth  currents  of  250  mil- 
liamperes.    At  the  end  of  this  time  she  could  lie  on  the  stomach  for 


Fig.  43. — Diagram  of  original  outline  of  Case  6. 


the  first  time  in  years,  and  the  upper  limit  of  the  tumor  was  two 
inches  below  the  navel.  She  was  seen  five  years  later  by  one  of  the 
hospital  nurses,  to  whom  she  declared  that  the  tumor  had  entirely 
disappeared. 

Case  No.  6.    A  single  woman,  aged  41,  was  referred  by  Dr.  Frank 
Woodbury,  with  a  history  of  hemorrhages  twelve  years  before,  at  which 


FIBROID    TUMORS. 


147 


time  the  tumor  was  first  discovered.  Tlie  menorrhagia  iiad  ceased  for 
some  time,  but  she  was  troubled  witli  menorrlialgia  and  a  most  ofren- 
sive  leucorrliea.  The  pelvis  and  lower  third  of  the  abdomen  were  filled 
with  an  irregular,  hard  mass,  extending  nearly  to  the  navel,  and 
separated  by  deep  sulci  into  three  lobes  (Fig.  43).  The  os  was  found 
with  difficulty,  but  was  so  stenotic  as  to  foil  all  attempts  at  inserting 
a  sound  or  electrode.  An  unsuccessful  attempt  was  made  to  insert  a 
steel  needle  into  the  tumor  through  the  abdominal  wall,  developing 


Fig.  44. — Diagram  of  original  outline  of  Case  7. 


the  fact  that  the  tumor  had  undergone  calcarous  degeneration  in  its 
upper  portion.  A  filiform  sound  was  now  passed  two  and  a  half  inches 
into  the  cavity  and  60  milliamperes  applied  successfully.  Two  days 
later  a  No.  18  wire,  tipped  with  solder,  was  inserted,  and  a  week  later 
an  ordinary  sound,  by  which  time  the  odor  had  disappeared  from  the 
discharge  and  never  returned.  The  treatment  was  kept  up  for  six 
months,  as  it  was  seen  that  a  diminution  was  taking  place,  at  which 
time  her  condition  was  as  follows:     General  health  much  improved, 


148  DISEASES    OF    WOMEN. 

no  leucorrhea,  no  menorrhalgia,  cavity  of  uterus  normal,  and  tumor 
shrunken  one-third.  Instead  of  being  three-lobed  it  now  consisted 
of  three  distinct  tumors,  movable  upon  one  another,  showing  that  the 
absorption  had  doubtless  occurred  jn  the  base  where  there  was  prob- 
ably no  calcareous  change.  She  reported  to  Dr.  Woodbury  recently 
that  the  tumor  had  disappeared. 

Case  No.  7,  referred  by  Dr.  Bradford,  presented  an  interstitial 
enlargement  of  the  uterus  to  the  size  nearly  filling  the  pelvis,  in  a 
patient  34  years  old.  There  was  a  subperitoneal  projection  on  the 
right  the  size  of  a  large  orange,  extending  up  into  the  abdominal  cavity 
to  a  level  with  the  anterior  superior  process  of  the  iliac  bone  (Fig. 
44).  She  suffered  from  a  copious  purulent  leucorrhea  and  constant 
pain  in  the  left  groin,  rendering  walking  difficult.  The  treatment 
consisted  of  intra-uterine  negative  applications,  beginning  with  50 
milliamperes  and  quickly  increasing  in  subsequent  applications  to 
150.  Symptomatic  improvement  began  very  shortly  and  reduction 
in  size  was  noted  in  the  second  month.  The  treatment  was  kept  up 
about  eight  months.  Examination  subsequently  showed  a  reduction 
of  the  uterus  to  normal  and  of  the  protuberant  portion  to  a  nodule 
no  larger  than  a  marble. 

Case  No.  13  was  the  wife  of  a  physician  in  a  Middle- Western 
State,  aged  48,  and  was  sent  to  the  sanatorium  by  the  late  Professor 
Goodell  as  not  suitable  for  operation.  She  was  having  alarming 
hemorrhages  almost  constantly,  which  kept  her  in  daily  fear  of  a 
fatal  issue.  The  tumor  was  very  large,  fully  as  large  as  an  adult  head, 
and  of  the  smooth,  hard,  monocentric-  variety,  the  cavity  being  spread 
out  on  the  right  side  with  an  extremely  thin  wall  on  one  side  and  a 
depth  of  five  inches  (Fig.  45).  It  had  evidently  developed  in  the  left 
wall  of  the  uterus  and  became  submucous,  but  so  large  as  to  spread 
the  organ  out  on  its  right.  Treatment  was  commenced  at  once  with 
a  carbon  electrode  of  large  size,  which  was  pressed  into  the  tumor 
rather  than  applied  to  different  portions  of  the  cavity,  as  in  sectional 
cauterization,  on  account  of  the  very  thin  right  wall.  The  hemor- 
rhages being  alarming  and  the  patient  more  than  usually  impatient, 
the  treatment  was  pushed  most  heroically, — some  twenty-two  treat- 
ments in  fifty-five  days:  about  every  other  day,  since  a  period  inter- 
vened during  the  applications.  Nearly  all  of  these  applications  were 
of  250  milliamperes  for  the  long  durations  of  ten  and  fifteen  minutes.. 
As  the  hemorrhages  were  now  arrested,  she  went  home,  but  the  natural 


FIBROID    TUMORS. 


149 


result  of  a  tedious  separation  of  a  portion  of  the  tumor  resulted,  with 
slight  rise  of  temperature.  After  this  part  came  away  the  remainder 
of  this  large  tumor  slowly  disappeared  by  absorption,  and  the  patient, 
when  heard  from,  ten  years  later,  in  March,  1898,  was  in  perfect 
health,  not  a  vestige  of  the  tumor  remaining. 

Case  No.  17.     This  patient,  a  multipara,  aged  34,  was  seen  at 
the  Howard  Hospital,  July  29,  1889,  with  an  hemorrhagic  fibroid 


Fig.  45. — Diagram  of  original  outline  of  Case  13. 


filling  the  pelvis  and  extending  above  the  level  of  the  iliae  bones. 
The  upper  portion  was  readily  felt  through  the  abdominal  wall,  being 
hard,  somewhat  flattened  in  shape,  and  with  an  irregular  surface 
(Fig.  46).  As  the  hemorrhage  had  lasted  this  time  nearly  two  weeks, 
treatment  was  begun  at  once  with  a  positive  intra-uterine  application 
of  110  milliamperes  and  continued  twice  a  week  for  two  months.  By 
September  27th,  on  which  day  the  last  application  was  given,  70  mil- 
liamperes strong,  the  tumor  was  almost  gone,  her  color  was  improved, 


150 


DISEASES    OF    WOMEN. 


and  she  was  gaining  flesh.  As  she  did  not  return  again  to  the  clinic, 
she  was  specially  sent  for  on  December  12th,  and  the  following  note 
made  after  examination  by  several  physicians  present:  "Examination 
shows  no  evidence  of  tumor.  The  only  abnormal  conditions  present 
are  a  thickening  of  the  cervix  on  one  side,  some  fixation  of  the  uterus, 
and  slight  leucorrhea.  She  states  that  her  periods  are  regular,  lasting 
but  three  days." 

Case  No.  20.    This  case,  a  patient  at  the  Howard  Hospital,  aged 


Fig.  46. — Diagram  of  original  outline  of  Case  17. 


30,  presented  a  singular  history,  the  exact  stages  of  which  are  left 
somewhat  indefinite,  owing  to  her  limited  intelligence.  On  exami- 
nation, August  12,  1889,  the  uterus  was  found  so  large  as  to  nearly 
fill  the  pelvis,  with  a  nodular  outline  at  the  fundus.  The  os  was 
virginal  and  the  cavity  measured  three  and  one-half  inches.  She 
had  been  complaining  of  painful  hemorrhages  every  three  weeks 
for  two  years.  An  intra-uterine  application  of  60  milliamperes  posi- 
tive was  made,  and  nothing  further  seen  of  the  patient  for  over  four 


FIBROID    TUMORS.  151 

months,  when  she  returned,  saying  that  it  had  caused  pain  twenty- 
four  hours  later,  followed  by  a  sanguineous  discharge  that  continued 
three  months,  two  weeks  of  which  had  been  spent  in  a  hospital.  Still 
complaining  of  pain  and  leucorrhea,  an  examination  showed  that  the 
tumor  was  much  reduced  (it  is  probable  that  a  portion  had  been  ex- 
truded). She  was  now  placed  on  vaginal  applications,  which  resulted 
in  complete  symptomatic  cure  by  January  31,  1890,  the  leucorrhea 
being  gone  and  the  periods  regular  and  painless.  The  hospital  notes 
of  this  date  say:    "No  sign  of  tumor  except  lumps  in  tubal  region.'^ 

Case  No.  23  was  also  seen  at  the  Howard  Hospital,  September 
18,  1889,  with  a  fibroid  tumor  situated  in  the  right  wall  of  the  uterus 
about  the  size  of  a  goose-egg  and  giving  a  history  of  a  year's  dura- 
tion, with  irritable  bladder  and  other  pressure  symptoms.  The 
treatment  was  intra-uterine  negative  applications  of  60  milliamperes. 
Two  months  later  there  was  considerable  reduction  in  size.  The  notes 
say,  under  date  of  November  1,  1889:  "Examination  shows  uterus 
quite  small  and  movable;  no  evidence  of  tumor."  This  condition 
was  found  to  persist  a  year  and  a  half  afterward  on  the  patient  being 
visited  at  her  home. 

Case  No.  24.  This  lady,  a  widow  aged  41,  presented  a  typical 
instance  of  a  small,  bleeding  fibroid  situated  in  the  posterior  wall  of 
the  uterus  so  near  the  cavity  as  to  give  rise  to  alarming  hemorrhages 
out  of  all  proportion  to  the  size  of  the  tumor.  At  her  periods  she 
stated  that  she  lost  as  much  as  some  do  in  child-birth.  Two  years 
previously  she  had  passed  a  polypus,  and  the  hemorrhage,  pain,  and 
tenderness  had  persisted  since  then,  becoming  worse  of  late.  The 
fibromatous  uterus  was  much  enlarged,  with  a  projection  on  postero- 
lateral aspect  and  a  cavity  three  and  one-half  inches  in  depth. 

The  treatment  of  this  case  lasted  exactly  three  months,  being 
positive  intra-uterine  applications  of  a  usual  strength  of  100  mil- 
liamperes with  platinum  electrode  (the  zinc-amalgam  method  not 
having  then  been  devised),  and  resulted  in  the  complete  cure  of  the 
pain  and  hemorrhages,  disappearance  of  the  tumor  by  absorption, 
and  reduction  of  the  cavity  to  two  and  one-half  inches.  Her  general 
health,  which  had  been  much  impaired  by  loss  of  blood,  was  com- 
pletely restored. 

Case  No.  35.  This  lady  was  sent  to  me  by  Dr.  Davis,  of  Bridge- 
ton,  N.  J.  She  was  50  years  old,  and  had  been  suffering  from  profuse 
and  irregular  menstruation  for  some  time,  but  the  tumor  was  not 


152 


DISEASES    OF    WOMEN. 


discovered  until  Dr.  Davis  found  it  to  be  the  cause  of  an  attack  of 
retention  of  the  urine.  When  admitted  to  the  sanatorium, — October 
17,  1890, — the  uterus  was  found  to  be  pressed  against  the  pubes  by 
a  hard  growth  attached  by  a  broad  pedicle  to  its  posterior  aspect,  and 
extending  from  a  level  of  the  os  to  within  two  inches  of  the  navel. 
Another  nodule  was  the  size  of  a  walnut  and  freely  movable  (Fig.  47). 
The  cavity  was  over  three  inches  in  depth.  As  the  bulk  of  the  tumor 
was  subperitoneal  and  the  lower  end  was  easily  accessible  through 
the  posterior  vaginal  vault,  the  treatment  was  by  buried  vaginal 


Fig.   47. — Original  outline  of  tumor  in   Case   35. 


puncture,  negative,  the  needle  being  inserted  from  one  to  one  and 
one-fourth  inches  beyond  the  vaginal  surface.  The  punctures  were 
all  negative,  and  varied  in  strength  from  100  to  150  milliamperes, 
no  anesthetic  being  required.  In  all,  ten  punctures  were  made,  a 
diminution  in  size  showing  after  the  second.  At  the  final  puncture, — 
March  2,  1891, — the  highest  point  was  four  and  a  half  inches  below 
the  navel, — a  reduction  of  two  and  a  half  inches  in  longitudinal 
diameter.  On  May  17th  of  the  same  year  she  returned  by  request, 
saying  that  it  was  impossible  to  feel  any  tumor  through  the  abdominal 


FIBROID    TUMOES. 


153 


wall.  This  was  verified,  no  growth  whatever  being  ascertainable  by 
external  palpation.  The  bimanual  showed  only  a  slight  roughness 
at  the  fundus  (Fig.  48).  At  tlie  present  time,  seven  years  after  ad- 
mission, her  health  continues  perfect,  so  far  as  the  tumor  is  concerned. 
Case  No.  38.  This  case  is  particularly  noteworthy  in  presenting 
the  history  of  complete  disappearance  of  the  largest  tumor  that,  so  far 
as  the  author  is  aware,  has  been  caused  to  disappear  by  electrically- 
induced  absorption  without  the  assistance  of  the  menopause.  The 
lady  in  whose  case  this  gratifying  result  has  occurred  was  a  widow 


Fisr.  48. — Outline  of  tumor  in  Case  35  after  treatment. 


46  years  of  age,  though  since  her  restoration  to  health  she  has  married 
a  second  time.  She  was  first  seen  by  the  author  on  January  31,  1891, 
having  been  kindly  referred  by  Dr.  G.  H.  "Whitcomb,  of  Greenwich, 
N.  Y.  The  growth  was  at  that  time  about  the  size  of  an  adult  head, 
the  upper  limit  about  one  and  a  half  inches  below  the  navel,  hard, 
knotty,  and  freely  movable  in  the  abdominal  cavity,  in  which  it 
mainly  lay  (Fig.  49).  Examination  showed  it  to  be  continuous  with 
the  uterus,  the  cavity  being  in  the  anterior  portion,  distorted,  and 
difficult  of  penetration;  large  projections  extended  to  the  right  and 


154 


DISEASES    OF    WOMEN. 


left  posteriorly.  The  patient  said  the  growth  had  been  discovered 
but  three  years  before,  though  preceded  by  the  intense  menorrh- 
spasms  from  which  she  still  suffered.  One  year  before  seeing  me 
she  had  been  placed  under  electric  treatment  by  Dr.  Whitcomb,  whose 
intelligent  application  of  the  Apostoli  method  resulted  in  great  relief 
of  pain  and  a  reduction  of  size  from  one  and  a  half  inches  above  the 
navel  to  the  same  distance  below  that  point.  The  treatment  had  been 
discontinued  for  some  time  before  the  case  first  came  under  my  obser- 
vation, but  since  her  removal  to  Philadelphia  there  had  been  a  recur- 


Fig.  49. — Original  outline  of  tumor  in  Case  38. 


rence  of  menstrual  pain  and  swelling  of  the  tumor,  and  she  was  also 
suffering  from  an  edematous  swelling  of  the  right  leg.  The  exami- 
nation showed  that  the  posterior  projection,  which  was  of  more  recent 
appearance,  probably  caused  the  edema  by  mechanically  interfering 
with  the  venous  circulation  of  the  leg. 

She  was  placed  on  vaginal  alternative  applications  of  150  mil- 
liamperes  and  subsequently  on  a  weaker  intra-uterine  dosage.  In 
three  weeks'  time  she  was  able  to  lay  aside  the  elastic  stocking  that 
she  had  been  wearing.  During  the  following  month,  however,  a  typi- 
cal attack  of  the  prevailing  influenza  put  her  back  somewhat,  and  I 


FIBROID    TUMORS. 


155 


was  afforded  an  opportunity  of  witnessing  an  example  of  the  intense 
menorrhspasms  with  which  she  had  been  afflicted,  accompanied  by 
a  swelling  of  the  tumor  to  the  level  of  the  navel  again.  The  treat- 
ment was,  nevertheless,  persisted  in,  and  I  had  the  satisfaction,  some 
months  later,  of  noting  a  great  reduction.  At  the  end  of  six  months' 
treatment  she  was  seen  again  by  Dr.  Whitcomb,  who  had  some  diffi- 
culty in  finding  the  tumor.  Six  months  later  it  had  entirely  dis- 
appeared (Fig.  50). 

The  case  was  examined  recently  by  the  author,  and  but  for  an 
abnormal  hardness  of  texture  and  a  slight  projection  the  size  of  a 


Fig.  50. — Outline  of  uterus  in  Case  38  after  treatment. 


split  almond  from  its  posterior  aspect,  the  uterus  could  not  be  distin- 
guished from  a  perfectly  normal  one.  The  enormous,  irregularly 
lobulated  growth  had  disappeared.  The  patient  menstruates  normally 
five  days  at  a  time,  and  without  pain;  showing  that  the  result  was 
not  assisted  by  the  menopause,  which  has  not  yet  appeared. 

Cases  Kos.  42  and  76  complete  the  list  of  tumors  that  diseppeared 
by  absorption,  and  are  sufficiently  described  in  the  table. 

Case  No.  46.  Mrs.  C.  M.  W.,  aged  45,  was  brought  to  the  sana- 
torium by  her  husband  on  March  20,  1891.  She  was  a  nullipara 
under  the  average  height,  and  the  immense  size  of  the  tumor,  in  con- 


156 


DISEASES    OF    WOMEN. 


junction  with  a  lateral  curvature  of  the  spine,  produced  a  most  notice- 
able deformity.  The  tumor  had  been  known  to  exist  for  fifteen  years 
and  had  been  accompanied  by  hemorrhages,  the  latter  having  ceased 
on  appearance  of  the  menopause  six  months  ago.  The  menopause  had 
not  been  of  service  in  ameliorating  the  condition  of  the  patient,  except 
in  the  matter  of  stopping  the  hemorrhages,  for  her  health  was  becom- 
ing worse  and  the  tumor  had  made  a  distinct  increase  in  size  during 
the  intervening  six  months. 

The  growth  was  somewhat  larger  than  the  uterus  at  term,  ex- 


Ularcfi  20*    isfi 


IlLavcfx   \Z^li 


_ecl?27f   18<11 


.marcfx  18^8 


Fig.  51. ^Outlines  of  tumor  in  Case  4G  at  various  dates. 


tending  four  and  one-fourth  inches  above  the  navel  and  increasing 
the  abnormal  waist  measure  to  thirty-seven  and  one-half  inches.  It 
projected  so  far  as  to  measure  eighteen  and  one-half  inches  from  spine 
to  spine  of  the  ilium  (Fig.  51). 

On  palpation  the  tumor  seemed  so  elastic  that  I  at  once  sus- 
pected a  semicystic  nature.  This  was  rendered  more  probable  by  the 
symmetrical  and  ovoid  shape  of  the  growth  and  the  fact  that  the 
cavity  could  not  be  entered  by  a  sound  to  a  greater  depth  than  three 
inches,  the  cervix  being  effaced.     Under  these  circumstances  my  de- 


FIBROID    TUMORS.  157 

cision  was  announced  that  the  Apostoli  treatment  would  be  inappli- 
cable, and  the  patient  was  urged  to  consent  to  a  consultation  with  a 
surgeon,  the  husband  being  sent  for  for  that  purpose. 

The  lady,  nevertheless,  positively  declined  surgical  treatment 
and  begged  me  to  do  what  I  could  with  electricity.  To  determine 
the  true  nature  of  the  growth  it  was  decided  to  aspirate  it  through 
the  abdominal  wall.  This  was  done  on  March  29th,  withdrawing 
one  and  one-eighth  ounces  of  a  serous  liquid  that  coagulated  on  stand- 
ing. On  microscopic  examination  by  Dr.  Alfred  Stengel,  of  the  Uni- 
versity Laboratory,  it  was  pronounced  a  mixture  of  blood  and  fluid 
from  a  broad-ligament  cyst,  though  no  proof  of  the  latter  was  found. 
A  second  aspiration  one  month  later  withdrew  two  ounces  of  the  same 
character  of  fluid.  The  fact  that  this  liquid  came  from  small  cavities 
successively  pierced  by  the  needle  was  not  out  of  keeping  with  other 
clinical  evidences  that  the  growth  was  a  fibromyoma  undergoing  cystic 
change  and  increase  in  size,  and  the  cavities  seemed  to  be  separated  by 
trabecular  processes.  But  probably  the  most  distinct  proof  of  its 
myomatous  nature  was  afforded  by  subsequent  evidence  that  showed 
that  it  would  temporarily  diminish  in  size  under  strong  percutaneous 
currents. 

These  punctures  for  diagnosis  having  been  so  well  borne  and  so 
easily  made,  owing  to  the  absence  of  any  structures  between  the  tumor 
and  abdominal  wall,  it  was  now  determined  to  employ  negative  ab- 
dominal punctures  after  the  method  described  on  page  138.  At  the 
first  puncture  60  milliamperes  were  used  with  three  needles.  Three 
days  later  the  measurements  were  three  and  three-fourths  inches  above 
navel,  and  seventeen  inches  between  iliac  spines;  the  circumference 
was  not  taken.  This  showed  some  diminution.  The  punctures  were 
now  made  regularly  at  periods  not  less  than  two  weeks,  the  current 
being  gradually  increased  to  150  milliamperes.  On  October  27,  1891, 
"the  tumor  had  decreased  to  two  and  one-half  inches  above  navel, 
fifteen  inches  between  spines,  and  thirty-five  inches  in  circumference, 
— a  very  notable  decrease  in  all  measurements.  The  patient  was  also 
in  greatly  improved  health. 

The  patient  now  came  from  her  home  in  New  York  City  for  a 
puncture  about  once  a  month,  the  current-strength  being  from  200 
to  300  milliamperes,  by  triple  puncture.  The  last  puncture  was  made 
March  14,  1893, — two  years  after  the  first.  In  June  of  this  year  the 
tumor  was  even  with  the  navel  and  the  abdominal  circumference  was 


158 


DISEASES    OF    WOMEN. 


but  thirty-two  inches,  in  spite  of  much  additional  flesh  in  conse- 
quence of  improved  health.  The  patient  continuing  under  occasional 
observation  since  the  cessation  of  treatment,  I  have  been  able  to  add 
to  the  measurements  in  the  cut  (Fig.  51)  that  taken  in  March, 
1894,  when  the  upper  limit  was  one  and  one-half  inches  below  the 
navel  and  the  circumference  thirty  and  one-half.  At  the  present  time 
the  growth  requires  careful  palpation  to  detect  it  and  the  patient 
is  in  perfect  health. 

Case  No.  61.    Mrs.  W.  A.  D.,  a  nullipara,  aged  39,  was  sent  to 


Fig.  .52. — Original  outline  of  tumor  in  Case  61,  showing  method  of 
treatment. 


the  sanatorium  on  September  29,  1892,  by  Drs.  Hemminger  and 
Bixler,  of  Carlisle,  Pa.  The  growth  had  been  discovered  by  Dr.  Hem- 
minger seven  years  before.  On  admission  the  uterus  presented  a 
symmetrical  enlargement  about  equal  to  the  fifth  month  of  preg- 
nancy, elastic  and  semifluctuating  in  consistency.  Through  the 
dilated  os  a  smooth  elastic  body  presented,  nearly  the  size  of  a  child's 
head.  This  was  the  lower  portion  of  a  vasculo-cystic  intra-uterine 
tumor  that  was  found  to  be  everywhere  adherent  to  the  interior  of 
the  uterus  except  around  the  internal  os  and  for  a  small  space  an- 


FIBEOID    TUMOES. 


159 


teriorly.  The  presenting  portion  projected  about  an  inch  beyond 
the  external  os;  similar  projections  had  been  removed  by  Dr.  Hem- 
minger  on  two  previous  occasions  by  means  of  the  ecraseur.  The 
patient  complained  of  but  little  pain,  but  was  disturbed  by  a  most 
copious  watery  discharge  and  was  much  reduced  in  health. 

The  cystic  nature  of  this  growth  clearly  contra-indicated  the  ordi- 
nary Apostoli  treatment,  and  after  considerable  hesitation  it  was 
determined  to  try  a  new  method  of  electrolytic  destruction  with  a 
bipolar  instrument  made  especially  for  the  case,  each  pole  terminating 
in  a  needle-point  about  half  an  inch  long,  the  points  being  immovably 


Fig.  53. — Outline  of  Case  61  after  treatment. 


fixed  a  half-inch  apart.  Before  beginning  this  the  ecraseur  was 
applied  to  remove  the  most  projecting  portion.  This  proved  both 
difficult  and  dangerous,  the  material  being  exceedingly  tough  and 
the  hemorrhage  so  frightful  as  to  cause  an  abandonment  of  the 
operation.  The  electrolytic  method  (Fig.  52)  was  now  begun,  and  300 
to  400  milliamperes  employed  for  ten  to  fifteen  minutes  daily,  with- 
out sensation  to  the  patient  other  than  slight  internal  warmth,  fol- 
lowed by  continuous  irrigation  with  a  weak  solution  of  permanganate 
of  potassium.  As  much  as  700  milliamperes  was  later  employed,  re- 
sulting in  a  material  reduction  by  actual  destruction  of  growth  at 


160  DISEASES    OF    WOMEN. 

each  sitting,  the  uterus  contracting  as  the  material  was  dissolved.  Not 
a  drop  of  blood  was  lost.  This  treatment  was  kept  np  more  or  less 
actively  for  six  months,  or  -mtil  May  9,  1893,  when  the  following  note 
was  made:  "Tumor  all  gone  except  base  attached  Ic  anterior  surface 
of  cavity.  The  cervix  admits  but  one  finger.  Other  nuclei  of  fibroid 
growth  are  now  shown  to  exist  in  the  walls  of  the  uterus,  which 
remains  longer  than  normal,  but  no  larger  than  a  small  pear." 

An  examination,  made  in  the  summer  of  1896,  showed  a  still 
further  diminution  in  size  of  the  uterus  (Fig.  53)  and  the  patient 
in  good  health. 

This  case  inaugurates  a  new  method  of  treating  vasculo-cystic 
intra-uterine  tumors  that  are  accessible  through  the  os,  and  it  is  a 
method  that  has  several  advantages  over  both  morcellation  and  hyster- 
ectomy, the  advantages  over  the  former  being  its  bloodlessness,  the 
fact  that  septic  absorption  is  rendered  dii^cult  by  the  electrolytic 
sealing  of  absorbents  at  the  junction  of  the  destroyed  and  unde- 
stroyed  tissues,  and  the  highly  antiseptic  nature  of  the  products  of 
electrolysis  with  so  strong  a  current.  Its  advantage  over  hysterectomy 
is  that  the  patient  may  get  rid  of  the  tumor  and  be  restored  to  health 
without  losing  any  of  her  organs,  even  the  uterus. 

Aseptic  precautions  are,  of  course,  essential  to  this  method  of 
treating  a  cystic  intra-uterine  growth;  but,  when  the  immensely 
antiseptic  effect  of  300  to  700  milliamperes  is  considered,  it  amounts 
mainly  to  a  problem  of  keeping  the  cavity  aseptic  between  treatments. 

This  was  done  in  this  case  by  placing  the  patient  on  a  rubber 
bed-pan  and  douching  the  interior  of  the  uterus  with  a  gentle  stream 
of  strong,  permanganate-of-potassium  solution,  maintained  continu- 
ously for  an  hour,  twice  a  day.  Nothing  less  thorough  would  have 
preserved  her  from  infection.  The  harmless  nature  of  the  solution 
employed  enabled  the  injections  to  be  kept  up  for  months. 

The  method  is  only  possible  when  the  cervix  is  dilated,  as  in  this 
case. 

In  addition  to  my  own  cases  thus  summarized  briefly  and  tabu- 
lated fully  in  Appendix  A,  I  shall  add  a  classification  of  the  results 
reported  by  the  Keiths  in  the  volume  referred  to,  as  arranged  by  my- 
self, for  the  authors  of  this  most  interesting  narrative  of  case  histories 
did  not  classify  the  results  themselves,  but  apparently  left  this  to  be 
done  by  their  readers. 


FIBEOID    TUMORS.  IGl 

Author's  Classification  of  the  Results  in  106  Cases  Reported  hy 
Drs.  Thomas  and  Shene  Keith: — 

Cases  resulting  in  anatomic  and  symptomatic  cure: 

(a)  Extruded  tlirough  cervix  in  whole  or  part.  3 

{]))  Disappeared  by  absorption 3 

Cases  resulting  in  symptomatic  cure: 

(a)  With  great  reduction  in  size 47 

(&)  With  slight  reduction  in  size 18 

(c)  Without  change  in  size 5 

Total  cases  resulting  in  practical  success 76 

Symptomatic  improvement  under  insufficient  treat- 
ment        8 

Symptomatic  improvement  only 13 

Total  cases  resulting  in  partial  success 21 

Failure  to  effect  change 6 

Made  worse 2 

Eesult  unknown 1 

Total  cases  treated 106 

The  present  status  of  the  Apostoli  treatment  of  fibroid  tumors 
is  not  completely  shown  without  a  reference  to  articles  by  Drs.  Grand 
and  Famarque,  Dr.  Apostoli's  assistants  in  PariS;,  and  by  Dr.  J.  H. 
Kellogg,  in  the  "International  System  of  Electro-Therapeutics."^  I 
reprint  also  a  more  recent  and  most  interesting  paper,  read  before  the 
American  Medical  Association,  at  Baltimore,^  by  Dr.  Lapthorn  Smith, 
of  Montreal,  who  was  one  of  the  first  to  employ  the  method  in  Amer- 
ica, and  who  did  more  than  any  other  to  render  it  popular  in  this 
country  by  translations  of  the  writings  of  its  originator  and  by  numer- 
ous papers  of  his  own.  Dr.  Lapthorn  Smith's  testimony  is  the  more 
valuable,  nevertheless,  as  the  judgment  of  one  who,  in  addition  to 
being  a  skillful  user  of  the  method,  is  a  surgeon  by  choice  and  by 
reason  of  a  large  practice. 


^  "International  System  of  Electro- Therapeutics,"  edited  by  H.  R.  Bigelow. 
Philadelphia:   The  F.  A.  Davis  Co.,  1894. 

^  Journal  of  the  American  Medical  Association,  August  10,  1895,  volume 
XXV,  page  226. 

11 


162  DISEASES    OF    WOMEN. 

''At  the  full  flow  of  the  tide  of  the  most  successful  surgery  the 
world  has  ever  known,  one  must  possess  a  good  deal  of  courage  of  his 
convictions  to  rise  in  the  presence  of  such  a  distinguished  audience 
as  this  to  even  discuss,  far  less  to  advocate,  the  treatment  of  tumors, 
even  the  most  benign,  by  any  other  method  than  the  surgeon's  knife. 

"Appearing  on  the  programme  of  this  meeting,  surrounded,  as 
this  paper  and  its  author  are,  by  papers  and  surgeons  advocating 
every  kind  of  surgical  treatment,  from  tying  the  uterine  arteries  to 
removing  nearly  all  the  pelvic  contents,  my  position  is  a  peculiarly 
difficult  one;  the  more  especially  as  I  have  been  trained  as  a  surgeon 
and  now  occupy  a  position  as  surgeon  in  several  hospitals,  where  I 
am  often  compelled  by  circumstances  to  treat  fibroids  by  surgical 
procedures. 

"It  is  only  fair  that  I  should  say  at  the  outset  that  I  did  not 
choose  this  topic  for  my  discourse;  it  was  assigned  to  me  by  our  es- 
teemed chairman,  who,  in  order  to  preserve  the  high  reputation  for 
impartiality  which  has  been  possessed  to  an  eminent  degree  by  the 
chairmen  of  this  section  of  the  Association  in  the  past,  no  doubt 
wished  that  justice  should  be  done  to  all  methods  of  treatment  at 
present  employed.  So  strong  is  my  own  personal  taste  for  surgery, 
especially  of  the  abdomen,  that  I  might  have  been  tempted  to  disobey 
the  chairman's  command  but  for  one  reason,  which  was  that  as  I  re- 
flected upon  my  work  during  the  past  seven  years  there  passed  before 
me  the  images  of  some  fifty  women  whom  I  had  treated  for  fibroids 
by  electricity:  first,  as  they  appeared  when  I  saw  them,  with  faces 
anxious  with  pain  and  blanched  from  hemorrhage,  and  then  after 
their  pain  had  been  relieved  and  their  bleeding  had  been  stopped  by 
galvanism  and  their  cheeks  had  resumed  a  rosy  hue;  these  fifty 
women's  faces  encourage  me  to  do  justice,  though  the  heavens  may 
fall,  to  the  treatment  which  has  cured  them. 

"Then  there  pass  before  me  the  dying  faces  of  ten  women  who 
were  treated  by  total  extirpation,  at  two  of  which  operations  I  was 
the  executioner;  at  six  of  which  I  was  first  or  second  assistant,  and 
at  two  of  which  I  was  only  a  spectator. 

"True,  the  majority  of  the  ten  operations  were  performed  in  the 
preantiseptic  days,  though  by  a  great  master  in  this  department  of 
our  art;  but  four  of  them  were  performed  within  the  last  few  years 
under  the  most  rigorous  aseptic  precautions  by  men  who  have  a  small 
mortality  in  general  for  abdominal  surgery. 


FIBROID    TUMOES.  163 

"The  memory  of  these  fifty  women  who  have  been  cured  by  elec- 
tricity, many  of  whom  I  could  find,  if  required,  and  many  of  whom 
to  this  day  stop  me  in  the  street  to  thank  me  and  it  for  their  rosy 
cheeks;  and  the  memory  of  those  ten  women  who  are  now  no  more,  all 
tell  me  that  I  would  be  a  traitor  to  the  cause  of  truth  if  I  remained 
silent,  not  only  out  of  season,  but  in  the  very  houi-  when  it  most 
needed  to  be  spoken. 

"True,  I  can  quiet  my  conscience  when  circumstances  compel 
me  to  operate,  by  the  reflection  that  one  woman  died  while  under 
electric  treatment,  not  through  electricity,  but  through  an  error  of 
diagnosis,  for  mistaking  a  tense,  impacted,  liquid  tumor  for  a  fibroid, 
which  would  not  have  been  made  if  the  abdomen  had  been  opened, 
or,  in  other  words,  if  the  treatment  had  been  surgical  instead  of  elec- 
tric. Thiu  is  the  one  and  only  case  in  which,  as  far  as  my  experience 
goes,  I  have  ever  had  to  seriously  regret  the  use  of  electricity. 

"I  can  still  further  soothe  my  conscience  when  I  am  compelled 
to  operate,  by  remembering  that  I  have  operated  on  ten  women,  seven 
by  abdominal  hysterectomy,  treating  the  stump  by  leaving  it  trans- 
fixed at  the  lower  angle  of  the  incision;  and  on  three  by  removal  of 
the  appendages,  tying  the  ovarian  arteries  low  down;  and  several 
others  treated  in  the  latter  manner,  at  which  I  was  assistant,  all  of 
whom  recovered  and  are  now  in  good  health. 

"When  I  visit  the  City  of  Brotherly  Love,  where  the  surgeons 
have  declared  war  to  the  knife  upon  the  electrode,  I  am  often  placed 
in  an  awkward  predicament.  When  I  tell  my  friend.  Dr.  Joseph 
Price,  that  I  am  going  to  spend  a  few  hours  at  the  electric  clinic 
with  Dr.  Massey,  he  is  surprised  that  a  man  of  my  intelligence  can 
waste  his  time  in  such  fiddle-faddling  nonsense,  and  it  is  useless  for 
me  to  assure  him  that  I  can  show  him  many  women  in  Canada,  from 
Manitoba,  in  the  west,  to  New  Brunswick,  in  the  east,  who  are  pictures 
of  health,  and  who  have  been  cured  by  electricity. 

"On  the  other  hand,  when  I  tell  my  friend.  Dr.  Massey,  that  I 
am  going  to  spend  the  morning  with  Dr.  Joseph  Price,  extirpating 
fibroids,  he  looks  with  pity  on  my  blood-thirsty  taste  and  misguided 
energy. 

"In  vain  I  tell  him  life  is  too  short  to  treat  all  my  fibroid  cases 
by  such  means. 

"In  this  someAvhat  peculiar  position  which  I  occupy,  I  have  one 
consolation,  and  that  is,  or,  at  least,  I  hope  that  it  will  be  so,  that  the 


164  DISEASES    or    WOMEN. 

conclusions  which  I  shall  presently  lay  before  you  are  those  of  one 
who  is  entirely  unbiased  and  non-partisan,  and  are  consequently  to 
be  accepted,  as  far  as  they  go,  in  good  faith. 

'■'My  own  opinion  on  the  present  status  of  electricity  in  the  treat- 
ment of  fibroids  is  fully  made  up,  and  I  shall  now  endeavor  to  lay 
it  plainly  and  honestly  before  you. 

"During  the  last  year  especiall}^  although  it  has  been  growing 
gradually  for  several  years,  the  conclusion  has  become  evident  that 
electricity  is  not  suitable  for  every  kind  of  case  nor  for  every  kind  of 
doctor. 

"But  it  is  as  true  to-day,  as  it  ever  was,  that,  for  the  cure  of  pain 
in,  and  bleeding  from,  the  uterus,  the  ap^jlication  of  the  positive  pole 
of  the  galvanic  current,  properly  applied  and  of  sufficient  strength, 
to  the  uterine  mucous  membrane  is,  in  the  majority  of  cases,  effective. 
The  percentage  of  successes  is  greatest  in  those  cases  in  which  the 
fibroid  growth  is  interstitial;  not  quite  so  great  in  the  cases  of  sub- 
mucous growths,  although  in  several  of  these  cases  a  few  applications 
have  been  followed  by  the  expulsion  of  the  tumor  from  th^  uterine 
cavity.  The  earlier  the  cases  come  under  treatment,  the  more  surely 
they  are  cured,  many  patients  with  small  interstitial  tumors  in  the  an- 
terior wall  having  been  completely  cured  by  me,  and  still  more  under 
the  care  of  others;  so  that  the  plea  for  the  early  treatment  of  fibroid 
tumors  by  electricity  is  quite  as  just  a  one  as  is  the  early  plea  for 
operative  treatment.  Indeed,  it  is  evan  more  so,  for,  while  we  can 
truthfully  say  that  the  electric  treatment,  when  undertaken  early 
and  with  a  correct  diagnosis,  is  at  the  present  day  entirely  devoid  of 
danger,  no  one  can  truthfully  say  the  same  of  the  treatment  by  opera- 
tion. In  fact,  I  am  sorry  to  say  that  no  one  knows  what  is  the  death- 
rate  of  the  latter  treatment.  Three  of  the  ten  deaths  which  I  have 
above  mentioned  have  never  been  reported,  and  six  of  them  were  only 
reported  at  my  urgent  solicitation. 

"May  there  not  be  many  other  similar  cases?  When  a  woman 
comes  to  a  doctor  for  menorrhagia  and  he  discovers  a  small  fibroid,  is 
he  to  urge  her  to  submit  to  an  operation,  when  he  knows  with  the 
greatest  skill  and  care  she  runs  the  risk  of  dying  from  the  operation, 
and,  if  left  alone,  the  death-rate  is  no  more  than  1  per  cent.,  while  with 
electric  treatment  the  risk  is  absolutely  nothing? 

"When  she  tells  me  that  she  will  not  submit  to  an  operation. 


FIBEOID    TUMORS.  165 

shall  I  assure  her  that  I  can  do  nothing  for  her,  when  I  carry  in  my 
pocket  the  record  of  fifty  similar  or  worse  cases  which  have  been  cured 
by  electricity?  Surely,  that  were  dishonest.  And  yet  the  temptation 
to  operate,  in  spite  of  the  danger  of  surgical  and  the  safety  of  electric 
treatment,  is  very  great, — too  great,  in  some  cases,  for  us  to  resist. 

"Ours  is  a  busy  life,  and  there  is  not  one  of  us  here  who  has  not 
often  felt  that  life  was  far  too  short  to  accomplish  all  the  good  that 
we  would  wish  to  do,  and,  for  the  want  of  a  few  more  hours  in  the 
day,  much  work  of  value  to  our  fellow-beings  must  go  undone.  With 
this  feeling  strong  within  us,  a  poor  woman  applies  at  the  out-patient 
department  of  our  hospital  with  a  small  interstitial  fibroid  which  has, 
however ,  doubled  or  trebled  the  bleeding  surface  of  the  uterine 
mucous  membrane.  We  believe  that  we  could  cure  her  by  a  long  and 
tedious  course  of  treatment  with  electricit}^,  from  ten  to  fifty  appli- 
cations; if  there  are  no  facilities  at  the  hospital,  then  at  our  office. 
If  at  the  hospital,  the  time  required  for  this  case  would  seriously 
encroach  upon  the  time  allotted  to  our  service  there;  if  at  an  office 
there  is  the  same,  as  well  as  other,  objections.  And  when  we  have 
made  the  sacrifice  and  cured  the  woman,  what  is  the  reward?  Per- 
haps, but  not  always,  the  woman's  thanks.  Our  own  feeling  of  having 
done  well,  surely.  But  when  we  turn  to  our  brethren,  whose  esteem 
is  and  should  be  the  greatest  incentive  that  we  can  look  for,  to  good 
work,  well  and  conscientiously  performed,  what  do  they  say?  We 
have  no  fresh  and  bleeding  tumor  to  take  to  the  medical  society  (as 
an  Indian  waves  a  Avhite  man's  scalp),  before  our  admiring  brethren, 
as  a  trophy  of  our  prowess  and  our  skill.  I  have  shown  the  Avomen 
over  and  over  again;  I  have  shown  their  clothing  which  had  to  be 
taken  in,  as  much  as  seven  inches,  owing  to  the  decrease  in  size;  the 
women  themselves  have  offered  to  state  on  oath  that  their  bleeding 
had  been  arrested,  their  pain  removed,  and  their  general  health  im- 
proved. How  were  these  triumphs  of  therapeutic  skill  received? 
With  loud  applause,  you  will  say.  No,  indeed!  The  praise  bestowed 
upon  the  exhibitor  of  even  an  apparently  healthy  appendix,  the  re- 
moval of  which  was  followed  by  the  death  of  the  patient,  is  wild  in 
its  enthusiasm,  when  compared  with  the  manner  in  which  is  received 
the  report  of  a  case  of  cure  by  electricity.  Indeed,  a  sincere  friend 
and  admirer  in  our  society  warned  me  privately  that  my  reputation 
was  injured  every  time  I  showed  a  woman  who  had  been  cured  by 
this  means,  and  he  urged  me  to  shoAv  no  more.    But  I  must  continue 


166  DISEASES    OF    WOMEX. 

to  cure  them  by  that  means  as  far  as  my  time-limit  and  life-limit  will 
allow. 

"How  different  when  we  report  an  operation,  whether  the  patient 
lives  or  dies.  Everybody  seems  pleased  and  praises  us  in  proportion 
to  the  danger  to  which  our  patient  has  been  exposed.  But  if  she  dies 
there  are  two,  at  least,  who  must  regret  that  it  was  performed, — the 
patient  and  the  doctor;  and  sometimes  there  are  the  husband  and  the 
little  children  to  be  thought  about.  But  how  much  easier  to  take  the 
patient  into  the  hospital  and  in  a  few  days  perform  hysterectomy, 
which  we  can  do  in  a  quarter  of  an  hour  sometimes.  It  is,  as  the 
French  say,  'un  mauvais  quart  d'heure/  but  it  is  soon  over  and  the 
patient's  fate  is  sealed  for  weal  or  woe  when  we  have  put  in  the  stitch 
which  closes  the  peritoneal  cavity. 

"After  that  the  house-surgeon  and  nurses  take  care  of  her,  and 
an  average  of  three  minutes  a  day  for  the  next  twenty  days  is  the  very 
most  she  requires  of  us.  But  with  the  electric  treatment,  what  with 
getting  the  patient  ready,  carrying  out  the  asepsis  of  the  vagina,  and 
adjusting  the  apparatus,  I  have  spent  as  much  as  one  hundred  precious 
hours  on  a  single  fibroid  case.  But  the  ovaries  remained  and  many 
of  the  women  are  now  the  happy  mothers  of  children  and  others  are 
happy  wives,  capable  of  having  children,  though  childless. 

"I  have  lately  asked  several  well-known  men,  men  of  the  highest 
surgical  reputation  (you  would  be  astonished  if  I  mentioned  their 
names),  whether  they  had  employed  the  electric  treatment  with  good 
results,  and  they  have  assured  me  that  they  had,  although  they  have 
never  reported  them;  and  when  I  asked  them  what  was  the  principal 
objection  to  it,  they  replied,  in  confidence,  that  it  took  too  much  of 
their  time.  And  this  I  admit  is  a  serious  objection  to  it,  but  not  an 
insurmountable  one.  There  are  two  ways  in  which  it  may  be  sur- 
mounted; one  is  by  having  an  assistant  whose  time  is  less  precious 
than  our  own,  who  has  been  trained  to  carry  out  the  treatment  with 
accuracy  and  care  when  we  prescribe  it  for  the  disease  which  our  more 
experienced  touch  has  diagnosed.  And  the  other  is  by  having  several 
rooms  and  a  nurse  to  prepare  the  patient,  including  the  antiseptic 
vaginal  douche,  and  by  devoting  two  afternoons  a  week,  and  having 
these  patients  come  only  at  that  time,  as  many  as  six  treatments  an 
hour  might  be  administered. 

"Never  before  has  it  been  so  well  demonstrated,  as  it  is  to-day, 
that  by  the  division  and  subdivision  of  labor  the  workmen  become 


FIBROID    TUMORS.  167 

more  and  more  expert.  It  does  not  suri^rise  me,  therefore,  that  the  best 
results  of  the  electric  treatment  of  fibroids  are  obtained  by  such  men 
as  Apostoli  and  Massey,  who  employ  this  treatment  alone.  They  both 
obtain  results  which  neither  I  nor  any  other  operating  gynecologist 
can  hope  for.  In  every  large  city  we  should  encourage  some  one  man 
to  establish  an  electro-therapeutic  clinic,  where  our  poor  patients, 
at  least,  might  obtain  the  benefit  of  his  skill  in  electric  technique, 
after  having  obtained  the  benefit  of  our  experienced  diagnosis;  in 
time,  his  reputation  would  reach  the  ears  of  the  rich,  and  he  would 
then  have  some  substantial  reward. 

"The  present  status  of  electricity  is  suffering  as  did  the  status 
of  abdominal  surgery  a  few  years  ago,  because  it  has  been  tried  by 
men  without  sufficient  experience,  and  has,  as  a  consequence,  been 
found  wanting.  The  electric  treatment  of  fibroids  requires  knowl- 
edge of  the  pelvic  contents  as  well  as  the  electrician's  knowledge  of 
the  power  he  is  wielding. 

"I  must  trespass  on  your  time  yet  a  little  more  while  I  refer  to 
two  points.  One,  a  claim  which  has  recently  been  made  by  Apostoli 
for  the  electric  treatment,  which  I  can  heartily  indorse;  and  the  other 
an  objection  which  has  been  made  to  it,  which  I  can  as  heartily  deny. 

"Apostoli  has  discovered  that  the  very  failures  of  electricity  can 
be  turned  to  advantage  in  the  following  manner:  It  has  been  found 
that  in  those  cases  where  the  electric  treatment  has  been  badly  borne 
and  has  been  followed  by  febrile  reaction,  so  that  the  patients  have 
been  turned  over  to  the  surgeon  for  operation,  the  presence  of  pus- 
tubes  and  pelvic  peritonitis  has  been  discovered.  Apostoli  has  pointed 
out  that  electricity  may  be  employed  as  a  diagnostic  agent  for  the 
purpose  of  detecting  diseased  appendages. 

"A  remarkable  instance  of  this  came  under  my  notice  over  a 
year  ago.  A  young  woman  who  had  been  employed  in  a  restaurant 
in  a  New  England  town  gradually  lost  her  health,  and  had  pain  and 
hemorrhage.  She  suffered  agony  with  her  periods,  which  came  too 
often  and  lasted  long;  so  that  her  face  was  blanched  and  haggard. 
There  was  no  difficulty  about  the  diagnosis,  as  the  tumor  was  large, 
round,  symmetrical,  in  the  median  line  extending  up  to  the  umbilicus, 
and  could  be  easily  seen  and  felt,  bulging  up  the  abdominal  wall. 
Several  physicians  in  the  United  States,  her  family  physician  in  Mon- 
treal, as  well  as  myself,  all  agreed  that  it  was  a  fibroid.  One  of  them 
had  tried  electricity  several  times,  but  always  with  bad  results,  and 


168  DISEASES    OF    WOMEN. 

SO  did  I.  As  she  was  laid  up  in  bed  for  several  days  each  time,  I  con- 
cluded that  the  appendages  were  diseased,  and  after  three  applications 
I  decided  to  stop  and  to  perform  celiotomy.  On  opening  the  abdo- 
men the  tumor  was  at  once  seen  surrounded  by  adherent  intestines, 
but  it  still  appeared  a  symmetrically  pear-shaped  fibroid.  I  could 
not,  however,  find  the  ovaries  and  tubes,  and,  while  digging  around 
for  them,  I  made  a  line  of  clearage  which,  being  followed  up,  I  was 
able  to  dissect  out  a  portion  of  the  tumor;  it  proved  to  be  a  sausage- 
shaped  pus-tube;  this  was  delivered  intact,  tied,  and  cut  off.  Then 
followed  a  large  cystic  ovary;  then  the  other  tube,  which  broke  and 
inundated  the  field  with  pus;  and  then  the  other  ovary,  by  which  time 
the  supposed  fibroid  was  gone  and  only  a  moderate-sized  uterus  re- 
mained. The  pelvis  was  carefully  washed  out  and  drained;  the  patient 
made  a  rapid  recovery  and  is  now  at  work  and  enjoying  perfect  health. 
So  that,  in  this  case,  Apostoli's  dictum,  that  when  the  application  of 
his  method  causes  febrile  reaction  the  tubes  are  badly  diseased,  was 
fully  borne  out. 

"Now,  the  objection  to  electricity  which  has  so  often  been  made 
to  it,  especially  by  one  of  my  most  esteemed  friends  in  Philadelphia, 
that  it  causes  adhesions,  is  not  true.  I  maintain  that  one  has  no  right 
to  bring  that  charge  (1)  if  fibroids  which  have  never  been  treated  by 
electricity  do  have  adhesions,  and  (2)  if  fibroids  which  have  been 
treated  by  electricity  can  be  proved  not  to  have  become  adherent. 

"Now,  I  am  in  a  position  to  prove  both  of  these  facts.  Wlien  in 
Baltimore  I  saw  the  abdomen  opened  for  fibroid,  but  it  was  so  adherent 
to  everything,  intestine  and  abdominal  walls,  that  the  operator,  one 
of  the  ablest  in  the  world,  did  not  consider  it  possible  even  to  get  the 
ovaries  out,  and  the  abdomen  was  sewed  up.  Now,  this  case,  the  most 
covered  with  adhesions  I  have  ever  seen,  you  will  say,  had  received 
many  applications  of  electricity,  and  so  I  thought,  judging  from  these 
statements,  must  have  been  the  case.  But  careful  inquiry  elicited 
the  fact  that  she  had  never  received  a  single  application  of  electricity. 
But  that  is  only  negative  evidence.  Let  us  see  about  some  positive 
evidence. 

"Three  or  four  years  ago  I  treated  a  lady,  head-mistress  of  a 
large  public  school  a  thousand  miles  away,  for  hemorrhage  and  pain, 
by  means  of  intra-uterine  positive  galvanism.  She  had  received  one 
year's  leave  of  absence  from  her  duties  and  the  commissioners  had 
advanced  her  one  year's  salary  in  order  to  regain  her  health,  she 


FIBROID    TUMORS.  160 

being  utterly  incapacitated  for  work.  You  may  imagine  that  she 
was  peculiarly  anxious  to  get  well,  and  therefore  submitted  to  a  very 
rigorous  application  of  the  treatment  three  times  a  week  with  great 
fortitude,  as  high  as  200  milliamperes  being  frequently  given  at  a 
time.  And  this  was  not  for  one  or  a  dozen  applications,  but  for  fifty 
times.  By  this  time  the  bleeding  and  pain  were  nearly,  if  not  entirely 
arrested,  and  I  advised  her  to  complete  the  cure  by  a  few  months'  rest 
at  her  old  home  down  by  the  sea  in  New  Brunswick.  This  she  did 
and  came  back  to  me  in  July  with  rosy  cheeks  and  sparkling  eyes. 
She  and  I  would  have  been  perfectly  satisfied  with  the  result,  and  I 
should  have  reported  her  among  my  cures,  had  it  not  been  for  one 
thing,  and  that  was  that  she  asked  me  the  question:  'Can  you  promise 
me  that  the  awful  hemorrhages  will  not  return  after  I  have  gone  to 
my  far-away  home  in  the  West?'  This  I  could  not  answer  her  affir- 
matively. 

"Her  next  question  was :  'Is  there  any'  other  treatment  by  which 
you  can  guarantee  that  result?'  My  reply  was  'Yes,  one  only,  and  that 
is  hysterectomy.'  Although  the  operation  was  not  required  by  her 
then  present  condition,  yet,  owing  to  her  financial  situation,  which 
would  preclude  her  ever  coming  to  Montreal  again,  at  her  urgent 
request  I  removed  her  uterus. 

"Now,  if  the  charges  against  electricity  have  a  vestige  of  truth 
in  them,  I  must  have  found  the  tumor  covered  with  adhesions;  in 
fact,  the  tumor  and  appendages  must  have  been  one  agglutinated 
mass  requiring  some  hours  of  patient  toil  to  detach  them,  and  for 
this  I  was  prepared.  But  what  was  my  astonishment,  on  opening  the 
abdomen  and  screwing  a  cork-screw  into  the  tumor  to  be  able  to  lift 
it  out  smooth  and  shining  as  the  top  of  a  bald  man's  head;  the  trans- 
fixing of  it  with  pins  and  circling  it  with  the  serre-neud  was  the  work 
of  a  few  moments  and  in  a  minute  more  the  tumor  was  off.  She  ran 
her  5  or  10  per  cent,  of  risk  of  death  safely,  and  made  a  splendid 
recovery  and  was  at  the  head  of  her  school  once  more  on  Septem- 
ber 1st. 

"One  such  case  carries  more  weight  than  a  thousand  assertions 
that  electricity  causes  adhesions. 

"But  I  can  duplicate  it.  A  young  lady  who  is  now  a. trusted 
nurse  in  a  New  York  hospital  came  to  me,  the  first  year  I  used  this 
treatment,  for  hemorrhage  and  pressure  symptoms  caused  by  a  large 
fibroid.     She  improved  so  much  that  I  decided  that  she  ought  to  go 


170  DISEASES    OF    WOMEX. 

home  b}'  the  time  she  had  received  fifty  applications.  But  after  the 
last  application  she  began  to  flow  before  the  time,  and  I  asked  her 
to  wait  until  it  stopped.  It  lasted  seventeen  days,  a  steady  little 
stream  of  dark-red  blood.  I  became  momentarily  discouraged  and 
advised  operation,  which  was  accepted,  but  I  handed  her  over  to  a 
more  experienced  operator  than  I  was,  at  that  time.  I  assisted  at  the 
operation  and  the  tumor  came  out  without  the  slightest  difficulty, 
and  was  removed  in  the  same  way  as  the  case  mentioned  above.  I 
examined  it  most  carefully  and  the  only  trace  of  an  adhesion  to  be 
found  was  a  spot  about  the  size  of  a  silver  5-cent  piece,  where  the 
tumor  had  rubbed  upon  the  brim  of  the  pelvis  on  the  right  side  and 
where  she  often  complained  of  pain  before  coming  to  me.  But  there 
was  not  a  sign  of  adhesion  in  the  track  of  the  electric  current  nor 
an}-where  else  except  this  one  spot.  The  hemorrhage  was  due  to  a  tiny 
opening  in  a  sinus  by  the  end  of  the  electrode. 

*T[  dislike  electricity,  personally,  because  it  takes  up  my  precious 
time,  but  I  want  it  to  get  fair  play  and  not  be  blamed  for  sins  that 
are  not  its  own. 

"There  is  one  charge,  however,  which  was  frequently  brought 
against  the  electric  treatment  of  fibroids  or  rather  against  a  method 
of  applying  it,  in  the  past,  and  which  was  well  deserved,  but  no  longer 
applicable,  because  no  longer  employed.  I  refer  to  the  method  of 
galvanic  puncture. 

"The  greatest  claim  for  the  electric  treatment  of  fibroids  that 
can  be  made  is  that  it  has  no  mortality  and  that  it  is  absolutely  safe. 
If  it  is  not  safer  than  any  other  treatment,  or,  in  fact,  unless  it  is 
absolutely  free  from  danger,  there  remains  only  one  advantage  in  its 
favor, — namely,  the  saving  of  the  ovaries.  But  galvanic  puncture, 
no  matter  how  performed,  whether  by  the  vagina  or  through  the 
abdominal  wall,  must  ever  be  a  procedure  fraught  with  danger,  and  is 
to-day  practically  abandoned.  If  anyone  still  uses  it,  in  the  cause 
of  electric  treatment  of  fibroids,  I  beseech  him  to  use  it  no  more.  The 
positive  pole  of  the  galvanic  current  gently  introduced  into  the  uterus 
will  accomplish  our  object  by  unseen,  but  no  less  certain,  means.  It 
dries  up  the  juicy,  bleeding,  mucous  membrane,  and  by  its  tonic 
action  upon  the  muscular  tissue  through  which  must  pass  the  vessels 
carrying  nourishment  to  the  tumor,  its  blood-supply  is  cut  off  just 
as  surely  as  though  we  tied  the  ovarian  arteries  which  supply  the  body 
of  the  uterus.    The  action  of  the  electric  current  as  applied  to  fibroids 


FIBROID    TUiIOE=.  I'M 

is  threefold.  The  first  is  not  mysterious:  it  is  but  the  arrest  of  circu- 
lation in  dilated  capillaries  by  an  electro-chemic  cautery-.  The  second 
is  no  more  difficult  to  understand  than  the  action  of  ergot  or  strych- 
nine; it  not  only  tones  up  the  vasomotor  system,  making  the  calibre 
of  the  arteries  less,  but  it  calls  into  play  the  special  and  remarkable 
power  which  the  uterus  possesses  of  controlling  its  own  circulation 
when  it  has  the  strength  to  contract.  The  third  effect  of  the  current, 
its  electrolytic  action,  is,  I  admit,  as  mysterious  as  it  has  ever  been, 
but  not  more  so  than  the  invariable  absorption  of  syphilitic  gum- 
matous deposits  following  the  administration  of  iodide  of  potassium. 
"VThether  what  we  call  electrolysis  means  the  actual  breaking  up  of 
an  organic  tissue  into  inorganic  atoms,  or  whether  it  means,  as  seems 
more  likely  to  me,  that  the  growth  deprived  of  its  blood-supply  under- 
goes fatty  degeneration  and  is  partly  eaten  up  by  phagocytosis,  stimu- 
lated to  greater  activity  by  the  trophic  nerves,  no  one  with  a  large 
experience  with  this  subtle  fluid  can  deny  that  a  uterus  infiltrated 
with  and  enlarged  by  the  deposit  of  fibrous  tissue,  whether  localized 
in  the  form  of  fibroids  or  diffused,  as  in  areolar  hyperplasia,  so  that 
the  sound  will  enter  four  or  five  inches,  will  invariably  diminish  in 
depth  by  means  of  electric  treatment. 

"Then  again,  what  is  the  enormously  enlarged  uterus  after  de- 
livery but  a  bleeding  myoma?  Does  it  not  stop  bleeding  when  the 
arteries  which  supply  it  with  blood  are  squeezed  by  its  contracting 
walls?  Does  it  not  rapidly  get  smaller  when,  for  the  want  of  blood 
and  exercise,  the  immense  mass  of  tissue  silently  undergoes  fatty 
degeneration  and  returns  to  the  blood,  from  whence  it  came? 

'•TTonderful  and  almost  incredible  as  the  total  disappearance  of 
a  fibroid  or  myoma  may  seem  to  some,  it  is  no  more  mysterious  than 
this  wonderful  process  of  nature  which  we  call  involution.  Have 
those  who  doubt,  and,  even  worse,  deny  the  power  of  electricity  to 
work  a  change  in  fibroids,  never  reduced  the  size  and  weight  of  a 
uterus  which  nature  had  failed  to  involute?  Has  Emmett  never  re- 
duced its  size  by  repairing  a  lacerated  cervix?  Have  Churchill  and 
Athill  and  ten  thousand  others  with  honored  names  never  reduced 
the  quantity  of  tissue  in  the  uterus  by  the  application  of  iodine?  Have 
not  a  hundred  thousand  others  ever  reduced  the  weight  of  the  blood 
and  muscle  and  areolar  tissue  in  the  heavy  uterus  by  means  of  glycerin 
and  hot  water  and  other  therapeutic  measures? 

"Then  whv,  in  the  name  of  reason  and  justice,  will  yon  deny  that 


172  DISEASES    OF    WOMEN. 

an  agent  which  we  can  see  blanching  tissues  before  our  eyes,  and 
making  muscles  of  every  kind  contract,,  why  will  you  deny,  I  say, 
that  it  can  diminish  the  blood-supply  to,  and  favor  the  fatty  degen- 
eration and  absorption  of,  the  fibrous  or  myomatous  uterus? 

"The  electric  treatment  of  fibroids,  reduced  to  the  above  simple 
equation  and  stripped  of  all  the  extravagant  claims  which  were  at 
first  made  for  it,  stands  to-day  upon  a  foundation  so  strong  and  true 
that  it  will  find  an  honorable  place  in  the  treatment  of  fibroids  as 
long  as  women  shall  dread  to  die  by  the  surgeon's  knife,  which  I 
believe  will  be  as  long  as  the  world  shall  last." 

These  eloquently  expressed  convictions  of  Dr.  Lapthorn  Smith 
are  so  important  that  I  deem  it  but  proper  that  his  paper  should  be 
quoted  in  its  entirety,  yet  I  must  take  exception  to  the  adverse  opinion 
expressed  concerning  electro-puncture.  That  this  method  should  be 
retained  in  the  hands  of  experts  only  I  will  fully  grant,  but  there 
has  been  nothing  in  my  personal  experience  to  condemn  the  method. 
To  show  that  my  position  is  borne  out  by  the  experience  of  others  I 
will  quote  a  recent  paper  from  the  Transactions  of  the  Edinburgh 
Obstetrical  Society  for  1896-1897  by  F.  W.  :N".  Haultain,  M.D., 
F.E. C.P.Ed.,  Lecturer  on  Midwifery  and  Gynecology  in  the  School 
of  Medicine  of  Edinburgh.    The  paper  was  read  on  March  10,  1897. 

'■'ilore  than  two  years  ago  I  gave  an  account  of  my  experience 
in  the  electrical  treatment  of  uterine  fibromyomata,  with,  perhaps, 
an  enthusiasm  as  to  the  benefits  to  be  derived  from  its  employment, 
which,  from  the  somewhat  limited  number  of  cases  cited,  might  be 
questionable.  Since  that  time  to  this  I  have  continued  to  follow  this 
method  of  treatment  in  similar  cases,  with  results  so  encouraging 
that  any  enthusiasm  then  shown  in  its  favor  is,  if  possible,  more 
pronounced. 

'T^t  is  not  my  intention  to  dilate  further  on  the  general  hem- 
ostatic and  curative  properties  of  the  treatment,  beyond  mentioning 
that  in  these  respects  it  has  since  amply  fulfilled  the  sanguine  ex- 
pectations I  then  formed  of  its  value;  but  it  is  my  desire  to  place 
before  you  a  record  of  three  cases,  treated  by  electro-negative  punct- 
ure, which  are,  perhaps,  of  more  than  usual  interest.  They  represent, 
I  may  add,  my  entire  experience  in  this  method  of  electrical  treat- 
ment. 

"Case  1.  Mrs.  H.,  aged  36,  had  suffered  for  many  j^ears  from  a 
large  uterine  fibroid,  which  had,  from  the  attendant  hemorrhage,  so 


FIBROID    TU.MOES.  173 

reduced  her  health  that  Dr.  Groom  decided  to  remove  her  appen- 
dages.    This  he  accordingly  did  on  the  29th  of  October,  1893. 

"The  operation,  unfortunately,  had  no  beneficial  effect,  either  in 
arresting  the  hemorrhage  or  the  growth  of  the  tumor,  and  her  con- 
dition went  from  bad  to  worse.  From  the  extension  downward  of 
the  tumor  into  the  pelvis,  pressure  symptoms  of  a  most  exaggerated 
degree  were  developed.  These  consisted  in  complete  urinary  incon- 
tinence after  previous  retention,  agonizing  pains  in  the  back,  cramps 
of  the  lower  extremities,  and  albuminuria, — probably  the  result  of 
pressure  on  the  ureters.  At  the  same  time  profuse  uterine  hemor- 
rhage rendered  her  exsanguine  to  a  marked  degree.  Except  under 
morphine  she  had,  for  months,  never  been  free  from  pain,  and,  quot- 
ing from  her  own  words,  she  'frequently  prayed  for  death  to  relieve 
her  sufferings.'  During  this  period  injections  of  ergotine  and  other 
forms  of  medicinal  treatment  had  been  assiduously  carried  out. 

"By  Dr.  Groom's  request  I  was  consulted  by  her  on  the  7th  of 
December,  1894,  as,  before  undergoing  hysterectomy,  which  had  been 
recommended,  she  wished  to  know  if  electricity  could  be  of  any 
benefit.  Though  apparently  hopeless,  I  determined  to  at  least  give 
her  a  trial  of  the  electric  treatment.  In  this  determination  I  was 
supported  by  Dr.  Milne  Murray,  who  saw  the  patient,  and  of  whose 
opinion  I  gladly  availed  myself.  The  local  condition,  on  examina- 
tion, showed  the  true  pelvis  to  be  filled  with  a  tumor,  which  en- 
croached on  the  vagina  to  such  an  extent  that  it  was  impossible  to 
reach  the  cervix,  which  was  high  above  the  symphysis  pubis.  The 
upper  border  of  the  growth  reached  to  three  fingers'  breadth  above 
the  umbilicus  (Fig.  54). 

"On  the  14th  of  December  I  commenced  the  electrical  treat- 
ment, and  adopted  electro-negative  puncture  through  the  posterior 
vaginal  wall  as  the  only  method  available.  At  this  sitting  I  was 
enabled  to  pass  a  current  of  150  milliamperes  without  great  discom- 
fort. The  treatment  was  repeated  on  the  21st;  and  on  the  23d  the 
patient  informed  me  that  since  the  last  application  she  had  been 
entirely  free  from  pain,  an  experience  she  had  not  had  for  months, 
and,  further,  that  she  could  retain  her  urine  while  in  the  recumbent 
position.  The  applications  were  continued  at  weekly  intervals,  and 
after  the  seventh  application,  on  the  26th  of  January,  she  had  abso- 
lute control  over  her  bladder  in  any  position.  Applications  were 
continued  twice  weekly  until  twenty  had  been  given,  and  as  the 


174 


DISEASES    OF    WOMEN. 


hemorrhage  had  now  considerably  abated,  and  the  pain  absolutely 
ceased,  treatment  was  discontinued  on  the  19th  of  March.  Unfort- 
unately, late  in  July,  feeling  particularly  well,  she  resumed  her  cor- 
sets and  went  for  a  long  walk,  with  the  result  that  the  old  pressure 
pains  and  urinary  symptoms  returned,  associated  with  severe  vomit- 
ing and  an  increase  in  the  albuminuria.  The  electrical  treatment 
was  again  continued  with  the  same  satisfactory  result  as  regards  symp- 
toms, and  after  the  tenth  application  I  was  astonished  to  find  that 
the  tumor  had  entirely  passed  into  the  abdominal  cavity,  and  the 


rig.  54. 


-Outline  of  tumor  in  Case  1  of  Dr.  Haultain's  before  treatment. 
(Haultain.) 


cervix  could  be  reached  with  ease.  Intra-uterine  positive  electricity 
was  now  commenced,  and  a  further  ten  applications  given,  treatment 
being  altogether  suspended  on  the  10th  of  October,  1895.  Since  that 
time  she  has  been  in  absolute  health;  menstruating  regularly,  for 
about  five  days;  and,  on  examination,  the  tumor  can  now  be  felt 
freely  movable  in  the  abdomen,  and  springing  from  the  fundus 
uteri,  its  upper  border  reaching  about  two  fingers'  breadth  above  the 
umbilicus  (Fig.  55).  It  would  thus  appear  that  the  tumor  was 
essentially  of  the  subperitoneal  type,  and  had  become  accidentally 


FIBROID    TUMORS. 


175 


incarcerated  in  the  pelvis,  where  it  had  continued  to  grow,  but,  after 
having  become  diminished  in  bulk,  it  had  returned  to  the  abdominal 
cavity. 

"Case  2.  Miss  S.,  aged  38,  consulted  me  in  February,  1893,  on 
account  of  a  large  fibroid  tumor  which,  for  a  week  previously,  had 
caused  complete  retention  of  urine,  and  necessitated  the  regular  use 
of  the  catheter.  For  some  weeks  before  this  time  she  had  suffered 
from  occasional  transient  attacks  of  urinary  retention,  which  occurred 
about  her  menstrual  period.  She  had  already  consulted  an  eminent 
specialist,  who  stated  that  nothing  short  of  complete  removal  of  the 


Fig.  55. — Case  1  after  treatment.      (Haultain.) 


growth  would  benefit  her;  but,  having  heard  from  a  friend  about 
the  electrical  treatment  of  tumors,  she  decided  to  try  if,  by  this 
means,  anything  could  be  done  for  her,  before,  as  she  graphically 
put  it,  she  allowed  herself  to  be  ^cut  up.' 

"Beyond  the  urinary  retention  and  its  associated  discomfort,  she 
did  not  complain  of  any  other  well-marked  pressure  symptoms.  She 
was  stout  and  plethoric  in  appearance,  and,  further  than  suffering 
from  a  dull  and  almost  constant  headache,  and  a  feeling  of  weight 
and  fullness  from  the  presence  of  the  tumor,  she  felt  strong  and  well. 
She  menstruated  regularlv.  but  scantilv,  for  about  two   davs.      On 


176 


DISEASES    OF    WOMEN. 


examination,  a  large,  solid  swelling  could  be  felt  in  the  abdomen, 
reaching  to  two  fingers'  breadth  above  the  umbilicus,  continuous  with 
a  large  solid  mass  within  the  pelvis,  which  so  obstructed  the  vaginal 
examination  that  the  cervix  could  not  be  reached  (see  diagram,  Fig. 
56).  Energetic  attempts  to  push  the  pelvic  portion  of  the  tumor 
above  the  pelvic  brim  proved  absolutely  futile,  though  made  with 
the  patient  anesthetized  and  placed  in  the  prone  and  genu-pectoral 
positions. 

"Treatment  by  electro-negative  puncture  was  commenced  on  the 


Fi?.  56. — Outline  of  tumor  in  Case  2  of  Dr.  Haultain's  before  treatment. 

(Haultain.) 


24th  of  March,  a  strength  of  current  of  180  milliamperes  being  used, 
with  the  astonishing  result  that  spontaneous  micturition  could  be 
accomplished  the  same  afternoon,  and  from  that  day  to  this  a  catheter 
has  never  been  again  required.  The  first  menstrual  period  was  ex- 
tremely profuse,  and  lasted  ten  days.  Subsequently,  fifteen  electro- 
punctures  were  made  within  the  next  ten  weeks,  and  by  the  middle 
of  May  the  growth  had  so  materially  lessened  in  size  that  I  could 
with  difficulty  reach  the  cervix,  and  was  able  to  introduce  the  elec- 
trode within  the  uterus.  The  cavity  measured  four  and  three-fourths 
inches.     I  then  continued  the  treatment  by  giving  a  further  fifteen 


FIBROID    TUMOES. 


177 


applications  with  one  electrode  in  this  situation.  I,  however,  main- 
tained the  intra-uterine  pole  negative,  as,  from  the  increased  men- 
strual periods  her  headaches  had  ceased,  and  I  feared  that  the  posi- 
tive pole  might  here  cause  a  diminution  in  the  amount,  which  would 
be  injurious. 

"After  the  completion  of  the  treatment  the  patient  returned  to 
her  home  in  London,  and  I  did  not  see  her  again  till  six  weeks  ago. 
On  examination  then  I  found  the  tumor  still  pelvic,  situated  on  the 
posterior  uterine  wall,  and  about  the  size  of  a  small  cocoa-nut,  the 
uterus  and  the  tumor  being  freely  movable  together.     The  cervix 


Fig.  57. — Case  2  after  treatment.     (Haultain.) 


was  easily  reached,  and  the  sound  passed  into  the  uterine  cavity  about 
three  and  a  half  inches:  one  and  one-fourth  inches  less  than  when 
first  measured  (Fig.  57). 

"The  patient  described  herself  as  being  in  perfect  health,  and 
her  menstruation  perfectly  regular,  but  much  increased  in  amount. 
The  tumor  in  this  instance  was  evidently  intraligamentary,  as,  though 
free  from  incarceration,  it  still  retained  its  position  within  the  pelvis. 

"Case  3.  Mrs.  B.,  aged  46,  was  recommended  to  me  by  Dr.  Mac- 
donald  Eobertson  in  May  last.  She  suffered  from  complete  urinary 
retention,  which  had  continued  for  three  days.     She  had  had  pre- 


178  DISEASES    OF    WOMEN. 

vious  transient  attacks  of  similar  nature.  Menstruation  regular  and 
normal. 

"On  examination,  a  large  tumor  was  found  impacted  in  the  pelvic 
brim,  tilting  the  uterus  high  above  the  symphysis  pubis.  Attempts 
at  reposition  into  the  abdomen  were  futile.  Electro-negative  puncture 
was  adopted,  with  the  effect  that  the  same  afternoon  she  was  able, 
with  difhculty,  spontaneously  to  void  urine.  Eetention,  however, 
recurred  the  following  day,  and  persisted  till  the  next  application  of 
the  battery,  when  again  the  urine  could  be  temporarily  voided  vol- 
untarily. After  the  third  application  retention  did  not  recur;  after 
this,  two  applications  were  made,  but  the  patient,  being  extremely 
nervous,  refused  further  treatment.  Since  that  time  I  have  not  again 
seen  her,  but  hear  from  Dr.  Eobertson  that  he  has  not  again  been 
troubled  to  pass  the  catheter,  and  she  says  she  feels  quite  well. 

"On  carefully  reviewing  the  salient  features  of  the  result  of  the 
electrical  treatment  of  the  cases  I  have  just  described,  the  outstand- 
ing benefit  derived  in  one  and  all  is  the  rapid  removal  of  the  pressure 
symptoms.  This,  in  the  last  two,  was  so  immediate  in  its  occurrence 
as  to  be  difficult  to  credit;  while  in  the  first  case,  though  somewhat 
slower  in  its  development,  it  was  equally  striking.  That  this  result 
is  due  to  actual  shrinkage  in  the  size  of  the  tumor  there  can  be  no 
reasonable  doubt.  Though  inappreciable  at  first  to  the  examining 
fingers,  the  subsequent  course  of  Cases  1  and  2,  as.  well  as  the  want 
of  other  reasonable  explanation,  fully  justifies  this  assumption. 

"In  Cases  2  and  3  symptoms  of  pressure  had  only  been  experi- 
enced for  a  few  days,  and  therefore  any  great  diminution  in  the  size 
of  the  tumor  was  probably  unnecessary  to  relieve  the  urgent  condi- 
tions present,  and  can  be  accounted  for  by  contraction  of  the  capsule. 
In  Case  1,  on  the  other  hand,  severe  pressure  symptoms  had  been 
present  for  months,  and  were  becoming  aggravated  from  the  con- 
tinued growth  of  the  tumor,  and  thus  a  considerable  diminution  in 
the  size  of  the  growth  was  necessary  before  they  could  be  removed. 
That  this  shrinkage  in  the  size  of  the  tumor  was  permanent,  and 
not  merely  a  temporary  benefit  of  the  treatment  (as  is  averred  by 
many  to  be  the  only  value  of  electrical  treatment),  there  is  no  gain- 
saying. In  Cases  1  and  2  no  treatment  has  been  adopted  for  more 
than  eighteen  months,  yet,  not  only  have  the  symptoms  of  pressure 
entirely  subsided,  but  marked  diminution  in  the  size  of  the  tumor 
is  palpable.     The  sudden  recurrence  of  pressure  symptoms  in  Case 


FIBROID    TUMOES.  179 

1  is  easily  to  be  accounted  for  by  tiie  corsets  pushing  the  tumor 
deeper  into  the  pelvis. 

"Perhaps  the  outstanding  feature  in  the  cfE'ect  of  the  electrical 
treatment  in  Case  1  is  its  success  after  the  removal  of  the  uterine 
appendages  had  failed.  It  would  appear,  from  the  writings  of  some 
eminent  gynecic  surgeons,  that  many  cases  previously  treated  by 
electricity  subsequently  find  their  way  to  them  to  be  cured.  Fortu- 
nately, such  a  necessity  has  in  my  experience  been  quite  the  excep- 
tion. In  fact,  I  cannot  recall  a  single  instance  in  my  knowledge. 
On  the  other  hand,  it  is  but  rarely  that  the  electrician  seems  to  have 
had  as  yet  the  opportunity  of  stepping  in  where  they  have  failed. 
The  case  I  have  cited  is,  as  far  as  I  am  aware,  the  only  one  published 
in  which  electricity  had  been  adopted  after  surgery  has  failed,  with 
the  exception  of  a  failure  of  Thornton's,^  in  which  he  sarcastically 
attributes  his  want  of  success  to  the  patient's  falling  into  the  hands 
of  the  electricians.  How  the  electricians  fared  he  does  not  venture 
to  state. 

"In  Case  2  a  somewhat  striking  result  was  the  increase  of  the 
menstrual  flow,  attended  by  an  entire  disappearance  of  the  continuous 
headache  from  which  the  patient  complained.  This  might  be  deemed 
probably  of  the  nature  of  an  accidental  coincidence,  were  it  not  that 
I  have  observed  the  same  results  in  other  patients.  It  would  appear 
that  some  exceptional  cases  of  fibromata,  even  though  associated  with 
an  enlarged  uterine  cavity,  instead  of  increasing  the  menstrual  flow, 
are  actually  associated  with  an  abnormal  diminution  in  its  amount, 
which  results  in  the  attendant  discomforts  of  plethora,  as  commonly 
met  with  at  the  menopause.  How  the  electrical  treatment  effects  an 
increase  in  the  flow  it  is  difficult  to  conjecture;  perhaps  it  may  be 
by  stimulating  ovarian  activity;  but  the  fact  remains  that  I  have 
several  times  met  with  this  curious  phenomenon,  which  has  been 
attended  by  most  beneficial  constitutional  results.  Doubtless  igno- 
rance of  the  mode  of  action  is  unsatisfactory;  and  it  is  perhaps  this 
want  of  knowledge  which  has  influenced  many  in  giving  electricity 
so  wide  a  birth,  and  not  a  few  to  condemn  it  wholesale.  But  satis- 
factory results  are  all-important,  and,  so  far  as  I  personally  am  con- 
cerned, suffice  to  stimulate  me  to  work  contentedly  in  darkness,  as 
probably  by  this  means  alone  will  any  rays  of  light  be  attained. 


^  Playfair  and  Allbutt,  "System  of  Gynecology,"  page  629. 


180  DISEASES    OF    WOMEK. 

"A  further  point  of  very  considerable  practical  bearing  is  that, 
in  Case  1,  after  thirty  puncture  applications,  the  tumor  rose  out  of 
the  pelvis  into  the  abdominal  cavity.  It  thus  shows  that  if  judicious 
puncture  methods  are  employed  there  need  be  no  fixing  of  the  growth 
by  dense  adhesions  to  surrounding  structures;  and  thus  the  argu- 
ment used  by  certain  writers,  that  electrical  treatment  seriously  in- 
creases the  difficulties  of  future  operation  by  causing  dense  adhe- 
sions, must,  so  far  as  this  case  proves,  be  absolutely  groundless.  Cer- 
tainly where  the  old,  crude  methods  of  puncture  were  employed 
such  a  result  was  almost  a  necessity;  but,  with  the  insertion  of  the 
exposed  portion  of  the  electrode  well  within  the  tumor,  as  now  em- 
ployed, this  complication  is  efi&ciently  avoided.^ 

"The  practical  results  obtained  from  the  treatment  of  the  above 
cases  by  electro-puncture,  I  think,  thoroughly  justify  its  adoption. 
Doubtless  but  three  cases  are  too  few  from  which  to  form  definite 
conclusions;  but  cases  necessitating  the  employment  of  puncture 
methods  are  fortunately  rare,  and  where  the  intra-uterine  method  can 
be  undertaken  it  should  always  be  adopted,  the  results  being  equally 
satisfactory,  less  irksome  to  carry  out,  and  associated  with  probably 
less  risk  to  the  patient.  As  I  have  already  stated,  the  cases  cited 
represent  my  entire  personal  experience  in  the  electro-puncture 
methods,  or,  in  other  words,  were  all  that  I  have  seen  (among  over 
eighty  cases  in  which  I  have  adopted  electrical  treatment)  in  which 
I  have  been  imable  to  insert  the  electrode  into  the  uterine  cavity. 

"If  such  beneficial  effects  are  to  be  got  from  a  conservative 
method  in  the  treatment  of  fibromyomata,  it  is,  indeed,  surprising 
how  little  its  adoption  is  advocated,  not  to  say  how  heartily  it  is 
abused. 

"May  be  this  is  due  to  medical  'electricity'  forming  the  trade- 
mark of  so  many  advertising  quacks,  which  thus  shock  the  modest 
conservatism  of  the  high-toned,  professional  mind;  may  be,  on  the 
other  hand,  it  is  the  prolonged  irksome  nature  of  the  treatment  which 
prevents  its  adoption  by  the  busy  gynecologist;  or,  perhaps,  its 
methods  are  too  simple  and  commonplace  to  induce  the  laparotomist 
to  leave  the  beaten  track  of  the  linea  alba,  on  which  he  is  ever  trying 


'  Dr.  Haultain  explains,  in  an  unquoted  portion  of  the  paper,  that  he 
employs  buried  puncture,  the  details  being  similar  to  those  given  in  the  present 
work  and  probably  first  suggested  by  me  in  the  first  edition  of  "Electricity  in 
the  Diseases  of  A\^omen,"  in  1889. 


FIBROID    TUMORS.  181 

to  establish  world-records  of  statistical  successes.  But,  whatever  the 
cause  may  be,  I  think  there  can  be  little  doubt,  from  a  conservative 
point  of  view,  that  the  electrical  treatment  of  fibroids  has  not  as  yet 
had  bestowed  upon  it  the  consideration  which  its  results  warrant. 

"It  has  its  failures;  but  what  methods  have  none?  It  has,  how- 
ever, no  mortality  (this  I  state  from  personal  experience  and  observa- 
tion), and  here,  undoubtedly,  rests  the  main  argument  in  favor  of  its 
adoption  before  other  heroic  measures  are  attempted. 

"Eemoval  of  the  appendages  has,  in  the  hands  of  the  average 
operator,  a  mortality  of  8  per  cent.,  and  in  a  further  10  per  cent, 
fails  in  any  way  to  benefit  the  patient.  According  to  Croom,  20  per 
cent,  of  women  continue  to  menstruate  after  this  operation.  Fur- 
ther, in  a  considerable  proportion  of  cases  in  which  this  operation 
has  been  begun  it  is  unable  to  be  completed. 

"Hysterectomy,  in  the  hands  of  the  most  able  and  finished  opera- 
tors, has  a  mortality  of  10  per  cent.,  and  an  average  mortality  of  quite 
three  times  that  amount. 

"Surely,  then,  if  electricity  as  a  conservative  measure  has  any 
beneficial  results  whatever  (and  I  can  personally  vouch  for  a  perma- 
nent removal  of  symptoms  for  over  two  years  of  over  70  per  cent, 
of  cases),  surely  it  cannot  be  altogether  rejected  and  refused  a  legiti- 
mate trial. 

"The  two  main  conclusions  which  may  be  arrived  at  from  the 
cases  quoted  seem  to  me  to  be: — 

"1.  That  electricity  has  a  decided  curative  action  in  some  cases 
of  fibromyomata,  when  nothing  else  short  of  severe  surgical  measures 
can  be  recommended. 

"2.  That  from  the  absence  of  mortality  in  its  employment,  and 
also  in  that  it  in  no  way  increases  the  danger  of  subsequent  opera- 
tion, electricity  should,  in  a  large  proportion  of  cases  of  fibromyo- 
mata, be  employed  before  recourse  be  had  to  radical  surgical  inter- 
ference. 

"I  do  not  wish  to  be  sentimental,  but  I  appeal  to  human  inclina- 
tions. In  a  case  of  one  who  is  near  and  dear,  who  suffers  from 
chronic  invalidism  as  the  result  of  a  uterine  fibromyoma,  I  ask 
whether  many  of  us  Avould  subject  her  to  an  8-per-cent.  risk  of  life, 
with  a  further  15-per-cent.  risk  of  failure  by  removal  of  the  ovaries, 
or  the  terrible  mutilation  of  hysterectomy,  before  at  least  trying  all 
conservative  means  at  our  disposal.     Personally,  I  unhesitatingly  say 


182  DISEASES    OF    WOMEN. 

I  would  decline,  and  thus  would  give  electricity,  as  the  most  effi- 
cient conservative  treatment,  an  honest  trial.  ISo  harm  is  done,  no 
valuable  time  is  lost,  for  in  the  majority  of  instances  fibromyomata 
do  not  call  for  immediate  interference.  If  it  do  fail — which  in  my 
experience  is  the  exception — we  can  then  proceed  with  an  easy  con- 
science to  other  more  radical  and  drastic  measures.  Why  ovaries  and 
uteri  should  be  treated  with  less  courtesy  than  other  important  organs 
(not  to  mention  the  teeth,  which  have  bestowed  on  them  in  many 
instances  infinitely  more  care  and  trouble  to  conserve  them)  is  an 
enigma  difficult  to  explain.  Perhaps  woman  is  herself  to  blame,  the 
tendency  of  the  age  being  to  minimize  the  importance  of  these  repro- 
ductive functions,  of  which  her  matronly  ancestors  were  so  proud. 

"It  such  be  so,  it  is  little  credit  to  the  medical  profession  to 
foster  the  idea  by  condemning  these  organs,  for  but  minor  offenses, 
to  capital  punishment  without  any  option." 

Dr.  Lackie,  in  the  discussion  of  Dr.  Haultain's  paper,  said  that 
he  had  had  an  opportunity  of  watching  one  of  the  cases  which  Dr. 
Haultain  had  recorded.  The  patient  at  one  time  seemed  to  him  to 
be  dying  from  pressure  symptoms  and  exhaustion,  but  the  effect  of 
the  electrical  treatment  which  Dr.  Haultain  carried  out  was  such  that 
now  she  seemed  perfectly  well.  Hysterectomy  was  out  of  the  ques- 
tion, as  the  patient  almost  certainly  could  not  have  borne  the  shock 
of  the  operation;  and  as  it  was  impossible  to  reach  the  interior  of 
the  uterus  on  account  of  its  displacement,  he  did  not  know  any  other 
means  that  would  have  reduced  the  tumor  and  so  saved  the  life  of 
the  patient.  Dr.  Lackie  had  recently  observed  in  another  case  the 
effect  of  electricity  in  causing  contraction  of  the  uterus.  Under  this 
treatment  a  bleeding  sessile  fibroid  had  rapidly  become  polypoidal, 
and  been  easily  removed,  with  great  relief  of  symptoms. 


CHAPTER  XL 

Displacements  and  Non-traumatic  Relaxations  or  the 
Pelvic  Viscera. 

Ti-ie  subject  of  displacements  of  the  uterus  occupies  a  large 
share  of  the  attention  of  practical  gynecologists,  partly  on  account 
of  their  inherent  importance,  and  partly  because  the  sufferings  due 
to  other  conditions  have  been  too  frequently  attributed  to  the  dis- 
placement, under  the  ultramechanical  development  of  the  older  gyne- 
cology, which  regarded  each  elaborately  classified  bend  or  tilt  as  a 
pathologic  entity,  to  be  corrected  by  a  specially  shaped  pessary.  Fort- 
unately for  our  reputation  for  common  sense,  these  several  bends  and 
tilts,  with  the  exception  of  retroflexion  and  prolapse,  may  now  be 
regarded  as  of  no  more  practical  importance,  'per  se,  than  the  shape 
of  the  patient's  nose.  Unless  the  bend  or  tilt  is  accompanied  by  a 
catarrhal  or  hyperplastic  condition  or  by  fixation  of  the  uterus  or 
other  abnormality,  it  possesses  absolutely  no  significance.  The  uterus 
being  normally  a  most  mobile  organ,  it  is  readily  seen  that  the  chief 
enemies  of  its  static  equilibrium  are  fixation,  on  the  one  hand,  and 
either  torn  or  atrophied  supports  or  undue  bulk  on  the  other,  and  that 
our  therapeutic  efforts  should  be  directed  to  a  removal  of  these  more 
important  accompaniments. 

It  is  most  important,  also,  to  ascertain  the  chronologic  sequence 
of  the  congestion  or  hyperplasia  and  the  displacement  in  cases  of 
mobile  prolapse  and  retroversion  not  due  to  laceration,  and  here  is 
where  a  singular  lapsus  occurs  in  the  current  views  of  many  gyne- 
cologists, who,  while  fully  convinced  of  the  microbic  and  neural  cau- 
sation of  other  infiammations,  still  adhere  to  the  older  theory  of  a 
mechanical  cause  for  this  one.  My  experience  with  two  classes  of 
young  women  has  convinced  me  that  the  congestion  and  enlargement  of 
the  uterus  is  the  initial  lesion  in  all  cases  except  those  due  to  lacer- 
ation of  the  pelvic  floor  at  childbirth,  the  displacement  being  second- 
ary and  sequential;  the  proof  of  this  is  the  great  rarity  of  prolapse 
and  retroversion  in   nulliparous  peasant  women   who    carry  heavy 

(183) 


184  DISEASES    OF    WOMEN. 

weights,  and  the  invariable  association  of  endometritis  with  the  very 
earliest  stage  of  (and  doubtless  preceding)  the  prolapse  or  retroversion 
of  young  women  of  the  better  classes.  This  sequence  of  events  applies 
equally  well  to  puerperal  subinvolutions,  which  are  a  most  fruitful 
source  of  displacements  and  relaxed  ligaments.  In  these  cases  all 
admit  that  the  causal  condition  is  the  failure  of  the  physiologic 
changes  that  normally  reduce  bulk  and  replace  effete  muscular  tissues. 
The  hypertrophy  necessarily  antedates  the  displacement. 

It  is  not  to  be  denied,  of  course,  that  the  elevation  of  an  enlarged 
and  catarrhal  or  subinvoluted  uterus  by  a  pessary  may,  at  times, 
relieve  the  intrinsic  condition  of  the  organ,  though  it  usually  fails 
to  do  so;  but  this  occasional  result  is  no  reason  to  assume  that  the 
displacement  or  tilt  was  primary.  Unless  the  advocates  of  the 
mechanical  theory  are  prepared  to  affirm  that  the  bend,  tilt,  or  descent 
is  to  act  the  part  of  the  microbe  in  this  particular  inflammation,  they 
should  admit  that  its  etiology  must  be  the  usual  one,  and  that  the 
uterus  has  become  tilted  or  prolapsed  because  it  had  become  heavier  as 
a  result  of  the  catarrhal  attack.  This  reasoning  does  not  exclude  the 
mechanical  contributing  causes  of  retroversion  and  prolapse  in  non- 
lacerated  cases  due  to  the  pressure  of  a  tight  corset,  lifting  weights, 
or  a  sudden  Jar  or  fall,  but  explains  how  these  mechanical  causes, 
acting  upon  an  already  heavy  uterus,  are  enabled  to  effect  a  disloca- 
tion of  an  organ  naturally  capable  of  most  extensive  movements  with- 
out harm. 

The  bearing  of  this  question  of  the  chronologic  sequence  of  the 
congestion  and  displacement  on  the  practical  details  of  treatment  is 
evident.  An  actual  cure  demands  that  particular  attention  be  paid  to 
the  hyperplasia  primarily, 'or  to  its  cause  in  endometritis,  metritis,  or 
other  inflammatory  conditions  that  may  still  exist,  and,  if  the  remedy 
employed  be  the  galvanic  current,  a  concurrent  treatment  of  the  re- 
laxed supports  is  also  gained.  A  therapeusis  aimed  merely  at  the  effects 
of  these  trophic  disturbances — the  sagging — is  unscientific  and  at  times 
harmful.  What  can  be  worse  in  its  effect  upon  already  weakened 
muscular  structures  than  placing  them  in  splints  by  the  employment  of 
a  pessary?  Nature,  surely,  never  designed  that  a  skeleton  should  exist 
within  the  vagina,  and  if  the  purpose  of  the  physician  in  placing  one 
there  be  not  to  improve  upon  nature's  permanent  arrangements,  but 
merely  to  use  this  means  to  strengthen  the  muscles,  it  should  be  re- 
called that  the  whole  teaching  of  the  modern  treatment  of  muscular 


DISPLACEMENTS    AND    EELAXATIONS.  185 

insufficiencies  tends  to  magnify  the  value  of  gymnastics  and  to  dis- 
credit support  and  fixation.  Many  cases  of  moderate  descent  of  a 
too-heavy  uterus  have  been  rendered  permanently  incurable  by  the 
persistent  use  of  these  contrivances,  causing  atrophy  of  the  vaginal 
muscular  layers  and  round  ligaments.  Their  only  proper  indication  is 
in  the  incurably  dilated  vaginas  of  middle-aged  or  elderly  women, 
where  a  properly  fitting  support  gives  immense  comfort,  and  should 
be  worn,  under  frequent  observation,  until  senile  involution  contracts 
the  vagina  and  renders  the  uterus  smaller. 

ELECTRIC    TEEATMENT. 

The  Author's  Method. — The  pathologic  basis  for  the  use  of  elec- 
tricity in  displacements  and  relaxation  of  the  pelvic  structures  with- 
out fixation  is  of  a  twofold  nature,  dependent,  on  the  one  hand,  on 
its  power  to  cure  inflammatory  conditions  of  the  uterus  which  have 
produced  added  bulk  or  congestion,  and,  on  the  other,  due  to  its 
stimulation  of  the  muscular  structures  of  the  uterus  itself  and  its 
supports.  Viewed  in  either  light,  its  great  adaptability  as  a  curative 
agent  is  evident,  for  it  associates  the  two'  essentials  of  diminishing 
the  bulk  and  increasing  the  power  of  maintaining  it.  Clinical  results 
fully  bear  out  these  theoretic  conclusions,  the  only  exceptions  being 
cases  where  the  muscular  structures  have  entirely  disappeared  by 
fatty  degeneration. 

The  details  of  treatment  are  largely  dependent  on  whether  the 
organ  is  freely  movable  or  is  fixed  in  its  displaced  position  by  the 
adhesions  of  an  old  pelvic  peritonitis  or  by  diseased  appendages.  In 
the  latter  case  the  applications  must  be  restricted  to  the  vaginal 
method  until  a  considerable  mobility  has  been  gained,  when,  if  it  is 
deemed  wise  to  do  so,  the  intra-uterine  treatment  may  be  begun.  Here 
the  principal  source  of  suffering  is  usually  due  to  the  inflammatory 
conditions  external  to  the  uterus,  which,  in  addition  to  being  of 
prime  importance  of  themselves,  usually  constitute  a  bar  to  intra- 
uterine treatment  until  greatly  bettered.  Both  galvanic  currents  of 
50  milliamperes  or  more  and  secondary  faradic  currents  should  be 
used  at  each  seance,  with  a  cotton-covered  vaginal  electrode  and  ab- 
dominal pad.     (For  details  of  method  see  page  56.) 

If  the  uterus,  on  the  other  hand,  is  movable  and  evidently  larger 
than  it  should  be  in  the  particular  physiologic  condition  of  the  patient. 


186  DISEASES    OF    WOilEX. 

and  especially  if  there  be  a  purulent  leucorrhea,  positive  intra-uterine 
galvanic  applications  may  be  begun  at  once  with  an  appropriate  elec- 
trode, followed  by  the  contracting  primary  faradic  current.  It  is 
often  best  to  intersperse  several  vaginal  applications  between  the 
intra-uterine,  if  the  patient  is  in  a  position  to  receive  daily  or  tri- 
weekly treatment. 

Nothing  has  been  said,  so  far,  of  bipolar  faradic  applications  in 
displacements.  Where  the  faradic  current  alone  is  to  be  used,  I  usu- 
ally prefer  the  bipolar  method,  either  within  the  uterus  or  vagina, 
now  that  I  have  been  able  to  thoroughly  asepticize  the  instruments, 
but  as  I  rarely  employ  the  faradic  current  alone  in  these  cases  I  find 
it  best  to  use  the  same  monopolar  electrode  and  one  insertion  for 
both  currents,  turning  on  the  faradic  current  after  the  galvanic  has 
been  turned  off. 

The  intra-uterine  applications  suitable  to  the  curative  treatment 
of  the  conditions  underlying  retroflexion  or  prolapse  of  non-adherent 
uteri  are  exactly  similar  to  those  advised  in  chronic  metritis  (page 
95),  and  exactly  similar  contra-indications  govern  its  employment. 
It  is  usually  wise  to  correct  the  displacement,  however,  immediately 
before  each  application.  This  is  best  done,  in  early  and  painful  cases, 
by  placing  the  patient  in  the  knee-chest  position  and  replacing  the 
organ  by  manipulation  with  the  fingers,  assisted  by  gravity  and  by 
pressing  on  the  fundus  through  the  posterior  vault  with  a  pledget  of 
cotton  in  a  pair  of  dressing-forceps.  In  less  tender  cases  of  retro- 
flexion this  is  not  necessary,  the  repositing  being  easily  and  pain- 
lessly accomplished  by  inserting  the  sound-shaped  electrode  into  the 
retroflexed  cavity  with  the  patient  in  the  dorsal  position.  Pushing 
the  handle  toward  the  pubis,  the  tip  is  now  rotated  gently  forward 
before  turning  the  current  on,  the  action  of  the  sound  being  assisted 
by  pressure  of  the  tip  of  the  flnger  in  the  posterior  vault,  when  the 
fundus  will  usually  glide  easily  into  place  if  not  pushed  too  far  back 
against  the  promontory  of  the  sacrum.  The  current  is  now  turned  on, 
as  in  the  treatment  of  chronic  metritis,  the  contracting  faradic  cur- 
rent usually  following  immediately  after  the  positive  galvanic  ap- 
plication from  the  same  instrument. 

There  is  a  distinct  contraction,  usually  noticeable  in  these  cases, 
immediately  after  the  application,  and  it  is  extremely  rare  that  it  is 
necessary  or  wise,  in  the  author's  opinion,  to  follow  this  application 
up  with  any  kind  of  continued  support,  though  some  operators  use 


DISPLACEMENTS    AND    RELAXATIONS.  187 

a  wool  tampon  with  glycerole  of  tauuiu  or  boroglyceride  between 
treatments.  As  this  distends  the  vagina,  it  is  apt  to  measurably  in- 
terfere with  the  strengthening  of  its  muscular  coats:  a  distinct  object 
in  the  electric  treatment  of  these  conditions.  Without  its  use  the 
extent  of  reposition  required  at  each  succeeding  application  will  grad- 
ually become  lessened  until  that  more  or  less  permanent  residuum 
of  either  retroflexion  or  prolapse  is  attained  which  persists  after  prac- 
tical, symptomatic  cure,  even  when  all  evidences  of  hyperplasia  and 
inflammation  have  disappeared. 

Such  are  the  most  important  details  in  the  electric  treatment  of 
prolapse,  retroversion,  retroflexion,  and  the  occasional  cases  of  patho- 
logic anteversion,  accompanied,  as  they  usually  are  in  all  stages,  by 
engorgement,  hypertrophy,  or  periuterine  inflammatory  consequences, 
and  this  form  of  treatment  is  almost  always  capable  of  removing  pain, 
weight,  discharge,  constipation,  or  other  evidence  of  a  morbid  condi- 
tion. It  is  by  no  means  always  possible  to  entirely  correct  the  back- 
ward bend  of  the  uterus  or  the  downward  sagging  in  prolapse,  the 
former  being  due  to  a  local  atrophy  of  the  longitudinal  muscular 
fibres  of  the  uterus  and  the  latter  to  profound  changes  in  the  mus- 
cular and  fascial  supports  of  the  abdominal  pressure,  but  enough  im- 
provement may  be  gained  from  the  cure  of  the  intrinsic  uterine  in- 
flammatory conditions  to  take  away  all  unpleasant  sjmptoms  and 
leave  the  patient  unconscious  of  any  departure  from  the  normal  posi- 
tion and  shape  of  the  organ.  The  following  cases  are  excellent  illus- 
trations of  the  possibilities  of  benefit  from  the  measures  recom- 
mended in  prolapse,  the  cases  illustrating  other  displacements  being 
included  among  the  cases  of  chronic  metritis. 

A  young  lady  of  26  years,  sister  of  a  physician,  who  had  suffered 
from  menorrhalgia  and  probably  an  endometritis  since  puberty,  and 
had  been  dilated  two  years  before  seeing  me  with  but  slight  relief 
from  the  intense  pain  at  the  periods,  presented  the  typical  s}Tnptoms 
of  almost  complete  prolapse  at  time  of  consulting  me,  the  uterus  just 
presenting  at  the  vulvar  outlet.  The  body  of  the  organ  was  slightly 
enlarged  and  all  supports  relaxed,  the  vagina  being  distended  and 
thin-walled,  doubtless  from  the  fact  that  she  had  worn  a  Smith-Hodge 
pessary  for  eighteen  months.  The  pain  in  back,  bearing-down  sensa- 
tion, and  weight  were  so  great  as  to  incapacitate  her  for  the  most 
ordinary  activities.  Of  late,  she  had  been  sleepless  and  nervously 
exhausted.    The  pessary  was  at  once  removed  and  daily  vaginal  appli- 


188 


DISEASES    OF    WOMEN. 


cations  made  with  both  currents  for  three  weeks,  with  two  intra- 
uterine applications,  the  patient  being  told  that  she  would  feel  worse 
for  a  time.  Later,  intra-uterine  applications  were  employed  once  a 
week,  averaging  35  milliamperes.  At  the  end  of  two  months  the 
uterus  was  sensibly  smaller,  remained  higher,  and  gave  only  occasional 
symptoms  of  discomfort.  The  applications  were  now  made  once  a 
month  for  three  months,  resulting  in  complete  symptomatic  cure. 
An  examination  at  the  end  of  a  year  showed  the  uterus  in  only  mod- 


Fig.  58. — Sectional  view  of  a  case  of  hypertrophy  and  prohipse  of  the 
infravaginal  cervix. 


erate  prolapse,  the  vaginal  supports  firmer,  and  the  patient  uncon- 
scious of  any  remnant  of  the  trouble. 

G.  R.,  aged  20,  applied  at  the  clinic  of  the  Howard  Hospital  on 
August  20,  1897,  with  complete  prolapse  of  an  hj'pertrophied  uterus 
(Plate  XX  and  Fig.  58).  The  cervix  protruded  about  two  inches  be- 
yond the  vulva.  On  passing  the  sound  into  the  cavity  of  the  uterus 
it  entered  seven  inches.  Bimanual  examination  showed  that  the 
fundus  was  well  up  in  the  superior  strait.  The  condition  had  lasted 
two  months. 


PLATE  XIX 


,*'*iSS;_'^; 


Traumatic  Relaxation  of  the  Pelvic  Outlet  with  Cystocele  and  Rectoce 


icnmnoGE  cd  litii  tdo.' 


PLATE  XX. 


Hypertrophy  and  Prolapse  of  the  Infravaginal  Cervix  in  a  young  neqress 


mnac  a  udnmncE  co  lith.  ma^ 


DISPLACEMENTS    AND    RELAXATIONS.  18D 

The  protruding  cervix  was  pushed  within  the  vulva  and  an  intra- 
uterine application  of  mercuro-cupric  cataphoresis  made  with  80 
milliamperes,  followed  by  primary  faradic  current.  The  vagina  was 
then  packed  with  absorbent  wool.  On  September  3d  the  uterus  was 
still  within  the  vulva,  and  the  treatment  was  repeated  with  a  current 
of  40  milliamperes  at  this  time  and  on  four  subsequent  occasions, 
without  packing  the  vagina.  Two  months  later  the  uterus  was  nor- 
mal in  size  and  position. 

The  results  of  intra-uterine  treatment  for  retroversion  and  retro- 
flexion are  about  equal  in  effect  to  those  gained  in  prolapse,  it  usually 
being  easier  to  secure  a  symptomatic  cure  than  an  anatomic  one,  par- 
ticularly in  retroflexion,  though  the  anatomic  improvement  is  very 
great. 

Tripier's  Method. — The  distinctive  feature  of  Tripier's  method 
of  treating  displacements^  is  the  local  application  of  the  faradic  cur- 
rent to  the  atrophied  fibrils  of  muscular  tissue.  This  involves  the 
direct,  localized  action  of  this  current  on  the  convex  aspect  of  retro- 
flexion and  anteflexion.  In  retroflexion  the  current  is  localized  in  the 
anterior  wall  of  the  uterus,  therefore,  and  in  anteflexion  it  is  localized 
in  the  posterior  wall.  His  directions  for  the  treatment  of  anteflexion 
are  as  follow: — 

"The  first  thing  to  be  done  is  to  lubricate  the  rectal  probe  (Fig. 
59),  although  it  is  the  last  one  to  be  used,  as  later  the  operator  would 
have  no  disengaged  hand  to  do  so.  Then  a  towel  should  be  placed 
within  reach. 

"The  uterine  exciter  (Fig.  60),  having  been  dried  by  the  left  hand, 
is  inserted  into  the  uterus,  using  for  this  purpose  the  left  forefinger 
as  a  conductor.  After  this  the  rectal  probe  is  inserted;  this  is  the 
most  delicate  part  of  the  operation;  if  not  well  done  it  might  be  very 
painful.  The  olive  must  pass  the  internal  sphincter,  leaning  a  little 
on  its  upper  edge,  the  concavity  of  the  instrument  pointing  down- 
ward; after  this  it  should  be  pushed  forward,  below,  and  a  little  to 
the  left.  When  the  olive  has  thus  reached  the  bottom  of  the  con- 
cavity of  the  sacrum  a  pause  should  ensue,  then  turn  the  probe  while 
elevating  its  pavilion  so  that  the  concavity  of  the  curvature  is  turned 


^  "Engorgements  and  Displacements  of  the  Uterus,"  by  A.  Tripier,  "Inter- 
national System  of  Electro-Therapeutics,"  page  G-135.  Philadelphia:  The  F.  A. 
Davis  Co. 


190 


DISEASES    OF    WOMEX. 


upward,  and  in  this  way  cause  the  olive  to  face  the  rear  wall  of  the 
uterus.  It  would  naturally  seem  that,  on  account  of  the  development 
to  the  left  of  the  rectal  ampulla,  the  rotation  would  be  easier  on  that 


Fit;.  59.  life'.  W).  Fig.  61. 

PMgs.  59,  GO,  and  Gl. — Tripier's  rectal,  uterine,  and  vesical  electrodes 
for  displacements. 


side,  but  this  is  not  the  case;  I  have  always  found  it  infinitely  easier 
to  the  right,  and  I  have  tried  it  both  sides.  After  pushing  the  olive 
from  right  to  left  in  the  concavity  of  the  sacrum,  it  must  be  brought 


DISPLACEMENTS    AND    EELAXATIONS. 


191 


back  to  the  right,  while  turning  the  concavity  of  the  probe  more  and 
more  toward  the  right.  The  pavilion,  being  held  in  the  hand  of  the 
rectal  probe,  must  be  slowly  elevated  dnring  this  rotation  movement 
until  it  has  been  completely  effected.  This  precaution  is  necessary, 
first,  in  order  not  to  use  the  uterus  roughly;  then,  that  the  move- 
ment of  rotation  may  be  more  freely  effected. 


Fig.  62. — Tripier's  faradic  method  for  anteflexion. 

"When  the  curvature  of  the  probe  has  been  brought  parallel  to 
that  of  the  sacrum,  then  only  can  the  hand  be  gently  lowered,  push- 
ing lightly  so  that  the  olive  may  come  up,  sliding  against  the  wall  of 
the  uterus. 

"This  last  motion,  however,  must  only  be  accentuated  when  fara- 
dization has  begun,  in  order  to  give  it  strength  and  assure  a  sufficient 


192 


DISEASES    OF    WOMEN. 


contact.  The  rotation  movement  just  described  is  not  always  accom- 
plished without  meeting  with  some  resistance;  this  is  sometimes  easily 
overcome,  but  at  other  times  it  may  be  difficult.  The  operator  should 
be  able  to  judge  according  to  the  impression  received  by  the  hand 
controlling  the  probe.    The  most  ordinary  obstacle  to  this  maneuver 


Fig.   63. — Iripier's  method  of   faradic   treatment   for   retroflexion. 


is  the  presence  of  a  fecal  mass,  hard  or  soft,  and  it  is  something  that 
cannot  be  foreseen.  The  best  way  to  avoid  it  is  to  give  the  patient 
an  injection  of  oil  before  the  application. 

"The  rectal  exciter,  once  placed,  should  be  held  in  position;  then 
the  conduoting-cord  must  be  attached  with  the  right  hand,  which 


DlSPLACEAlEiS'TS    AND    RELAXATION  a.  193 

must,  at  the  same  time,  hold  the  uterine  exciter.  It  is  necessary  to 
get  accustomed  to  manage  these  two  exciters  with  the  same  hand,  the 
other  hand  being  free  to  control  the  faradic  battery  and  to  govern 
its  action.  This  hand  directing  the  apparatus  must,  however,  be 
able  now  and  then  to  assist  the  other  one,  if  any  cause  should  present 
itself  to  modify  the  connection  of  the  two  probes,  in  accentuating  the 
motion  of  the  rectal  probe.  The  fact  is  that  a  definite  position  can- 
not always  be  given  at  once  to  the  rectal  probe.  I  have  already  de- 
scribed one  obstacle  to  its  progress:  the  existence  of  a  fecal  mass  in 
the  intestine.  If  this  should  happen  to  be  of  any  considerable  size 
and  a  little  soft  it  might  cover  the  posterior  wall  of  the  uterus  as 
with  a  plaster,  which  could  only  be  penetrated  little  by  little  during 
the  application.  Muscular  contractions  form  another  obstacle  to 
placing  the  probe.  These  alter  the  form  of  the  cavity  where  the 
evolutions  take  place.  They  are  of  a  flexible  nature,  and  give  way 
under  the  influence  of  faradization;  however,  the  resistance  they 
present  cannot  be  overcome  at  once,  and  it  is  by  interrupting  the 
rotation  during  the  application  that  this  can  be  avoided. 

"In  retroversion  and  retroflexion  the  anterior  wall  of  the  uterus 
must  be  acted  upon  and  vesico-uterine  faradization  employed  (Fig. 
63).  The  patient  being  in  the  dorsal  position,  the  uterine  exciter  is 
first  inserted,  then  the  positive  vesical,  which  is  previously  lubricated. 
After  this  the  contacts  are  established  and  the  apparatus  put  in  action; 
the  same  hand  then  places  the  two  probes  in  the  required  contact. 
The  insertion  of  the  vesical  exciter  is  made  like  that  of  any  ordinary 
probe;  the  pavilion  (handle)  must  be  raised  at  the  time  of  operating, 
but  only  at  that  time,  so  as  to  lean  the  active  tips  on  the  anterior 
wall  of  the  uterus. 

"The  application  should  not  last  longer  than  three  minutes,  to 
avoid  fatisfuino:  the  muscular  structures." 


CHAPTER  XII. 

Eelaxation  and  Functional  Incapacity  of  the  Abdominal 
Walls  and  Visceea. 

In  the  remarks  on  the  general  examination  and  classification  of 
cases,  on  page  10,  emphasis  was  laid  on  the  necessity  for  distinguish- 
ing between  pelvic  affections  and  those  that  have  their  origin  in  re- 
laxations and  displacements  of  the  abdominal  viscera.  These  latter 
affections  are  almost  peculiar  to  women,  owing  to  the  frequency  with 
which  their  causation  may  he  traced  to  the  combined  effects  of  corset- 
wearing,  pregnancy,  and  sedentary  habits.  A  few  words  on  their 
clinical  aspects  is  most  necessary  in  a  treatise  on  the  conservative 
treatment  of  the  diseases  of  women,  and  particularly  in  this  work, 
owing  to  the  unique  value  of  a  certain  combination  of  electric  cur- 
rents in  their  alleviation. 

Few  women  pass  through  one  or  more  pregnancies  without  a  resid- 
ual weakening  of  the  abdominal  walls,  which,  if  uncorrected,  remains 
a  menace  to  their  intra-abdominal  tone  in  after-years.  No  one  can 
believe  for  a  moment  that  this  abdominal  laxity  and  protrusion  is  a 
necessary  sequence  of  pregnancy,  and  there  can  be  no  doubt  that  it 
owes  its  presence  to  the  pestilential  corset  imposed  upon  occidental 
women  by  a  barbarous  whim  of  our  civilization.  And  do  not  let  us 
be  self-deceived  on  this  point.  I  do  not  refer  at  all  to  tight-lacing 
and  its  horrible  results  on  the  abdominal  viscera,  but  to  the  so-called 
loose-fitting  corset  of  most  comfortable  shape,  whose  harmful  effect 
is  due  to  two  factors:  1.  It  supplements  the  natural  body- wall  of  the 
abdomen  by  an  artificial,  external  skeletal  support  never  intended 
by  nature,  resulting  in  atrophy  and  weakening  of  the  abdominal  mus- 
cles: the  natural  support  of  the  body-wall  at  this  point.  2.  During 
and  after  the  first  pregnancy  this  artificial  skeleton,  which  had  here- 
tofore been  a  moderately  equable  support  to  all  of  the  muscles  of  the 
abdomen,  is  efficient  in  the  upper  portion  onlv.  leaving  about  one- 
(194) 


KELAXATION    OF    ABDOMINAL    WALLS.  195 

half  unsupported  in  this  way,  and  resulting  in  a  removal  of  pressure 
and  consequent  protrusion  of  the  lower  half  of  the  abdomen.  This 
leads  directly  to  either  partial  or  general  enteroptosis,  or  displace- 
ment of  the  hollow  viscera,  and — if  there  is  a  tendency  to  fatty  de- 
generation of  the  organs — to  morbid  dilatations  also. 

The  dragging  sensations  and  backache  thus  produced  are  fre- 
quently mistaken  for  pelvic  disease,  though  often  not  associated  with 
any  abnormality  in  that  cavity.  Constipation  due  to  an  enlarged 
and  sacculated  colon  is  invariably  present;  and,  when  the  organs 
exhibit  also  a  weakened  musculation  owing  to  fatty  degeneration  of 
their  unstriated  muscular  coats,  we  may  have  profound  effects  on  the 
general  health  from  absorption  of  toxins  and  deficient  secretion  of 
the  glandular  organs.  An  arhythmic  heart-action  even  may  be  traced 
to  this  condition. 

The  most  effective  treatment  known  to  the  author  consists  in 
labile  applications  of  electric  currents  to  the  weakened  and  dilated 
organs  of  a  strength  that  will  induce  contraction,  as  well  as  pro- 
foundly stimulate  glandular  action.  Such  currents  must  be  from  100 
to  150  milliamperes,  which  I  believe  is  much  more  than  has  hereto- 
fore been  given  in  this  way,  and  should  be  simultaneously  combined 
with  the  most  powerful  primary  faradic  currents,  applied  from  an 
active  pad  on  the  abdomen  to  the  large  indifferent  pad  on  which 
the  patient  lies,  as  shown  in  Plate  V,  the  movements  given  to  the 
anterior  soaped  pad  resulting  in  a  form  of  abdominal  electro-massage 
of  great  service.  In  addition  to  following  the  direction  of  the  colon 
in  these  movements,  the  active  pad  should  be  passed  down  the  flanks 
on  each  side,  just  above  the  pelvic  bones,  to  further  reach  the  motor 
points  of  the  abdominal  muscles. 

The  powerful  currents  advised  are  by  no  means  limited  in  effect 
to  the  abdominal  muscles,  but  constitute  also  a  stimulus  to  the  con- 
traction of  the  dilated  intestines,  gradually  adding  tone  by  the  re- 
generation of  muscular  fibre.  The  galvanic  current  in  this  dose  can 
also  be  relied  on  to  stimulate  the  secretory  and  excretory  organs  of 
the  abdomen,  resulting  in  relief  of  constipation,  general  improvement 
in  blood-conditions,  and  disappearance  of  irregularities  in  heart-action. 
In  one  case  recently  under  treatment  an  improvement  in  the  rhythm 
of  the  heart  could  be  detected  after  each  application,  probably  due 
to  direct  stimulation  of  the  sympathetic  nerves  in  the  epigastric 
region. 


196  DISEASES    OF    WOMEN. 

In  pronoimced  cases  of  abdominal  relasation  it  will  be  wise  to 
hasten  relief  by  prescribing  a  suitable  abdominal  supporter  at  once, 
which  may  be  discarded  later  as  improvement  progresses. 


CHAPTER  XIII. 

The  Border-line  Between   Gynecology  and  Neurology. 

The  restriction  of  the  term  "gynecology"  to  the  pelvic  diseases 
of  woman  is  largely  artificial  and  often  harmful  in  leading  to  serious 
errors  of  practice.  The  science  of  the  diseases  of  woman  necessarily 
includes  an  account  of  all  of  the  affections  which  are  either  peculiar 
to  her  sex  or  which  are  so  frequently  manifested  among  women  as 
compared  with  men  as  to  be  more  or  less  sequential  to  their  general 
bodily,  mental,  and  emotional  natures.  That  there  is  no  self-evident 
line  between  the  strictly  pelvic  and  the  extrapelvic  affections  peculiar 
to  women  was  manifest  to  the  author  many  years  ago  while  enjoy- 
ing, at  different  times,  the  valuable  privilege  of  professional  asso- 
ciation with  two  of  the  most  prominent  practitioners  of  America  in 
apparently  different  lines  of  investigation, — Drs.  S.  Weir  Mitchell  and 
William  Goodell, — and  it  was  a  singular  fact  to  note  that  the  eminent 
neurologist  was  most  solicitous  that  his  cases  should  have  the  bene- 
fit of  skilled  surgical  advice  whenever  any  indications  even  pointed 
to  this  necessity,  while  the  eminent  surgeon,  at  the  height  of  his 
masterly  work  in  the  major  surgery  of  gynecology,  had  the  mental 
breadth  to  keep  his  private  hospital  filled  with  patients  undergoing 
what  was  strictly  neurologic  treatment,  while  he  might  have  easily 
followed  the  prevailing  fashion  and  -removed  the  ovaries  of  every  one 
of  them. 

But  the  average  of  professional  work  or  breadth  of  character 
cannot  be  predicated  from  such  men  as  these,  and  it  is  to  be  feared 
that  like  conditions  of  discernment  and  cool  judgment  are  often 
wanting  in  both  specialties,  though  it  cannot  be  said  of  the  neurolo- 
gists, at  least,  that  a  too-narrow  view-point  can  lead  so  easily  to  dis- 
aster to  the  patient. 

And,  indeed,  no  more  difficult  class  of  cases,  from  the  point  of 
view  of  their  diagnostic  classification,  can  be  found  in  the  practice 
of  medicine,  and  unless  the  physician  has  both  a  gynecic  and  neuro- 
logic  facet  to   his   crystallized   experience  he   mav   make   mistakes. 

(197) 


198  DISEASES    OF    WOMEN . 

The  author  particularly  recalls  a  case  under  his  care  before  the  de- 
velopment of  his  gynecic  training  where  evidences  of  hysteria  were 
associated  with  a  vulvar  discomfort,  which  could  have  been  none 
other  than  a  minute  caruncle.  An  imperfect  examination  was  made, 
but  the  slight  evidence  of  local  disease  did  not  seem  to  bear  an 
etiologic  relation  of  importance  to  the  very  manifest  hysteric  symp- 
toms existing,  and  the  case  was  treated  entirely  from  the  neurologist's 
stand-point  with  but  partially  satisfactory  results.  A  retrospective 
review  of  its  management  makes  it  evident  that  the  local  affection 
should  have  been  carefully  sought  for  and  remedied  simultaneously 
with  the  neurologic  treatment,  care  being  observed  to  so  adapt  and 
direct  the  latter  that  the  patient's  attention  shall  be  attracted  away 
from  an  undue  contemplation  of  the  local  symptoms. 

In  the  management  of  these  cases  of  manifest  hysteroid  condi- 
tions associated  with  local  disorder  or  lesion,  whether  pelvic  or  ex- 
trapelvic,  it  is  clearly  our  duty  to  correct  the  local  faults  while  pur- 
suing measures  to  eradicate  the  main  affection;  but  I  believe  the 
profession  will  agree  with  me  that  too  much  stress  has  been  laid  upon 
the  so-called  "reflex"  causes  of  nervous  disease  in  recent  years,  though 
no  one  can  deny  the  real  importance  of  reflex  nerve-strain  from  a 
degenerating  or  badly-functionating  organ.  Ovarian  congestion  and 
tenderness  have  been  specially  frequent  in  these  border-line  cases, 
and  these  organs  have  been  removed  time  and  again  for  conditions 
of  exaggerated  nervous  disorder  without  securing  the  expected  relief, 
for  the  simple  reason  that  the  ovary  was  not  the  seat  of  the  real  dis- 
ease, but  merely  the  spot  at  which  appears  the  peripheral  expression 
of  a  centric  disease  of  the  nervous  system.  Such  a  course  of  pro- 
cedure was,  moreover,  incorrect  in  the  nature  of  the  local  remedy 
applied,  for  it  should  not  be  forgotten  that  centric  disease  may 
be  favorably  affected  by  peripheral  applications  to  the  end-organs 
through  which  it  expresses  itself,  the  remedy  in  these  cases  not  hav- 
ing been  a  curative  removal  of  the  congestion  or  tenderness,  but  a 
violent  amputation  of  a  but-slightly-diseased  organ,  thus  adding  a 
distinct  blow  to  an  already-unpoised  nervous  system.  In  place  of 
such  heroic  procedures  we  should  substitute  the  locally  alterative 
action  of  vaginal  electricity,  which  is  capable  not  only  of  removing 
the  local  congestion  or  hyperplasia,  but,  also,  of  producing  a  very 
valuable  centripetal  effect  upon  the  disordered  cerebral  centres. 

An  interesting  demonstration  of  the  latter  truth  is  recalled  in 


BORDER-LINE    BETWEEN    GYNECOLOGY    AND    NEUROLOGY.         199 

the  case  of  a  young  lady  referred  to  the  author  some  years  ago  by 
Dr.  Pepper,, her  home  physician  reporting  that  the  pain  and  tender- 
ness in  the  region  of  the  left  ovary  had  become  so  great  that  she 
was  rapidly  drifting  into  the  dangers  of  morphinomania.  In  addition 
to  the  marked  hysteric  condition  present  there  was  distinct  bogginess 
in  the  region  of  the  ovary  complained  of.  This  speedily  diminished 
under  positive  vaginal  treatment  with  both  currents  applied  by  a 
small  cotton-covered  electrode  and  abdominal  pad,  associated  with 
removal  from  home  surroundings,  general  electricity,  and  massage, 
resulting  in  complete  cure.  The  local  conditions  of  this  case  were 
exactly  similar  to  those  of  the  following  cases,  both  of  which  were, 
however,  more  virulent  in  their  hysteric  condition,  and  ultimately 
illustrated  the  fallacy  of  the  theory  of  a  local  pelvic  origin  of  this 
protean  disease  of  the  brain. 

A  young  girl,  of  plain  Pennsylvania-German  parentage  and  the 
picture  of  wholesome  physical  girlhood,  was  the  patient  of  an  able 
practitioner  who  had  long  been  the  family  physician.  During  the 
serious  and  finally  fatal  illness  of  a  younger  sister  a  latent  neuro- 
pathic diathesis  became  prominent  in  this  patient,  who  went  through 
an  elaborate  mimicry  of  the  traumatic  spinal  meningitis  of  which  her 
sister  suffered  in  the  same  room,  and  seemed  desirous  of  diverting 
to  herself  all  the  attention  of  a  too-solicitous  mother.  After  various 
changes  in  the  manifestation  of  the  neuropathy,  and  many  thera- 
peutic efforts  on  the  part  of  her  physician,  she  was  sent  to  the  In- 
firmary for  Nervous  Diseases  and  placed  under  seclusion,  rest,  and 
massage  without  adequate  electric  treatment.  About  this  time  the 
patient's  attention  became  fixed  on  a  pain  in  the  pelvis,  aggravated 
at  the  periods,  and  her  physician  finally  decided  that  the  removal  of 
the  ovaries  would  be  wise,  which  was  successfully  done.  The  pain, 
however,  became  worse  than  ever  after  the  operation,  and  nearly  a 
year  afterward  her  physician  sent  her  to  the  author  in  despair.  The 
uterus  was  now  fixed  and  extremely  tender  at  the  stumps  of  the 
ovaries,  with  probably  one  or  more  irritating  ligatures  in  these  posi- 
tions, and  the  local  electric  treatment  that  she  was  willing  to  receive 
was  of  little  avail.  Obstinate  bowel  obstruction  gradually  developed 
later,  for  which  a  second  operation  was  performed,  this  operation 
revealing  a  post-operative  adhesion  between  the  appendix  and  the 
stump  of  the  right  ovary.  The  patient  failed  to  rally  from  this 
operation,  expiring  some  hours  later. 


200  DISEASES    OF    WOMEN. 

A  similar  case  in  some  respects  was  admitted  to  the  sanatorium 
from  Northern  Ohio  in  1895,  the  young  lady's  physician  sending  her 
for  treatment  for  an  adherent  right  ovary,  which  was  also  enlarged 
and  tender:  a  diagnosis  which  had  been  made  by  himself  and  a 
distinguished  surgeon  of  Cleveland.  Fortunately  for  the  possibilities 
of  a  fuller  diagnosis,  the  patient's  aunt  accompanied  her  to  Phila- 
delphia. An  examination  on  admission  led  me  to  conclude  that  the 
pain  complained  of  in  the  pelvis  was  mainly  uterine  in  seat,  no  con- 
siderable periuterine  or  ovarian  disease  being  manifest.  I  was,  more- 
over, led  to  suspect  an  overwhelming  neuropathic  taint  from  a  pecul- 
iar glitter  of  the  eye  which  will  frequently  be  found  in  hysteric  cases, 
and  from  the  very  apparent  evidences  that  her  family  were  unsus- 
pectingly fostering  her  aches  and  pains:  a  view  of  the  case  that  was 
not  shared,  at  this  time,  by  her  physician. 

She  was  placed  on  combined  neurologic  and  gynecic  treatment, 
consisting  of  general  galvanic  treatment,  massage,  and  regulated  ex- 
ercise, and  daily  vaginal  galvano-faradic  applications  interspersed  with 
weekly  intra-uterine  applications  of  the  same  currents,  and  was  sent 
home  in  a  greatly  improved  condition  with  full  directions  for  a  con- 
tinuance of  the  methods  at  the  hands  of  her  home  physician.  This 
gentleman  has  kindly  informed  me  since  that  the  methods  were  not 
continued,  but  that  laparotomy  with  removal  of  the  ovaries  was  per- 
formed instead  some  months  afterward,  these  organs  being  found 
normal  and  free  from  adhesions.  The  patient  unfortunately  suc- 
cumbed to  the  operation. 

The  fact  that  these  two  patients  died  as  a  consequence  of  the 
operative  procedures  undertaken  for  their  relief  is,  of  course,  not  in 
itself  a  condemnation  of  the  methods  or  the  theories  behind  them, 
for  in  both  cases  the  deaths  were  caused  by  accidental  circumstances 
connected  with  operations  that  are  usually  more  or  less  safely  per- 
formed, though  the  fact  that  such  possibilities  attend  a  method  of 
treatment  of  a  non-fatal  disease  should  never  be  lost  sight  of.  But 
that  clearer  after-sight  that  is  often  more  accurate  than  foresight 
shows  that  the  disease  was  disproportionate  to  the  remedy,  particu- 
larly when  we  consider  what  would  have  been  the  natural  history 
of  the  disease  if  all  therapeutic  efforts  had  been  withheld,  as  in  the 
cases  of  pneumonia  studied  by  the  elder  Flint  many  years  ago.  Un- 
doubtedly both  patients  would  have  been  still  living,  so  far  as  the 
diseases  under  consideration  were  concerned.     It  is  likely,  also,  that 


BOEDER-LINE    BETWEEN    GYNECOLOGY    AND    NEUIIOLOGY.         201 

both  would  have  been  better  by  reason  of  changed  internal  and  ex- 
ternal conditions  through  flux  of  time,  or  by  reason  of  the  too- 
indulgent  relatives  either  mending  their  ways  or  being  worried  to 
death;    at  any  rate  they — the  patients — would  have  been  living. 

But  entirely  apart  from  the  accidentally-fatal  results  noted  in 
the  two  cases,  each  case  indicated  in  another  way  that  the  Iqcal 
conditions  were  inadequate  in  themselves  to  cause  the  general  con- 
dition complained  of.  In  the  one  case  the  first  operation,  which  was 
in  every  way  an  immediate  success,  left  the  patient  in  an  unchanged 
neurotic  condition,  to  which  was  added  the  sufferings  from  post- 
operative sequels.  In  the  other  case  the  early  fatal  result  precluded 
any  estimate  of  the  effect  of  the  operation  in  relieving  pain,  but  by 
revealing  the  fact  that  there  was  no  organic  disease  or  morbid  adhe- 
sion present  the  operation  clearly  indicated  that  a  failure  in  this 
respect  would  have  attended  an  immediately  successful  result. 

A  thorough  study  of  cases  of  this  nature  conveys  several  valu- 
able lessons  to  the  thoughtful  physician,  chief  of  which  is  that  they, 
with  many  other  immediately  successful  cases,  demonstrate  ultimately 
the  unwisdom  of  removal  of  normal  ovaries  for  any  form  of  hysteria. 
Of  castration  for  curable  diseases  of  these  organs  reference  has  been 
made  elsewhere  in  these  pages  (page  114). 

A  second  lesson  admonishes  us  to  include  the  patient's  relatives 
in  our  scheme  of  treatment  when  it  is  impracticable  to  remove  the 
patient  from  their  influence  for  a  sufficiently  long  period.  In  the 
case  treated  after  the  first  operation  the  electric  treatment  was  ren- 
dered ineffective  by  the  fact  that  the  patient  remained  at  home  dur- 
ing its  continuance.  In  the  last  case  the  removal  from  home  infiu- 
ences  was  a  valuable  assistance  to  the  treatment  employed,  and  the 
patient  was  vastly  improved  when  circumstances  rendered  it  neces- 
sary for  her  to  return  to  surroundings  that  had  been  nervously  hurtful 
since  her  birth.  Had  it  been  possible  for  this  patient  to  have  ob- 
tained congenial  occupation  elsewhere,  which  was  suggested  at  the 
time,  there  is  no  doubt  but  what  a  complete  restoration  to  health 
would  have  occurred. 

The  Rest  Cure  in  the  Treatment  of  Hysteria  and  Hysteroid 
Affections. — There  is  no  question  of  the  very  great  value  of  the 
"rest  cure"  in  two  distinct  classes  of  affections:  the  hysteroid  con- 
ditions and  physical  prostration,  som-etimes  called  nervous  prostra- 
tion.    Dr.  Weir  Mitchell,  its  distinguished  originator,  conferred  a 


202  DISEASES    OF    AVOMEX. 

lasting  benefit  upon  humanity  in  making  this  method  popular,  and 
it  should  also  be  added  that  great  credit  in  this  connection  is  also 
due  the  late  Dr.  William  Goodell,  who  proved  that  many  so-called 
uterine  affections  were  of  really  neurotic  origin — "n^rve-mimicries 
of  uterine  disease"  and  distinctly  curable  by  this  method.  That  many 
cases  have  been  subjected  to  this  treatment  that  were  not  proper 
subjects  for  it,  and  that  it  has  been  imperfectly  applied,  does  not 
detract  from  its  value  when  skillfully  directed  in  properly  selected 
cases. 

It  is  probable  that  the  principal  failures  in  the  employment  of 
this  method  have  been  due  not  only  to  improperly  selected  cases, 
but  to  a  misapprehension  of  the  method  itself.  He  who  imagines 
thiAt  the  ''rest'"'  is  the  main  feature  of  the  method  in  any  case  other 
than  mere  physical  prostration  is  far  wide  of  the  mark.  This  con- 
venient and  pleasing  term  is  only  the  name  for  a  most  rigid  method 
of  treatment,  which  has  as  its  chief  elements  the  replacement  of  drug 
medication  by  valuable  physical  methods  of  affecting  the  body,  asso- 
ciated with  a  rigid  diet  and  a  command  of  the  will-power  of  the 
individual.  In  most  cases  the  rest  is  a  mere  incident  in  the  sub- 
jection of  the  patient  to  more  important  influences. 

I  have  already  said  that  its  chief  field  lies  in  the  hysteroid  con- 
ditions, and  in  these  the  most  rigid  application  of  its  rules  is  most 
valuable.  Without  attempting  the  difficult  task  of  defining  these  con- 
ditions I  wish  to  point  out  that  cases  with  hypochrondriac  symptoms 
are  not  necessarily  hysteroid,  but  often  neurasthenic,  as  decribed  in 
the  next  chapter,  and  that  these  cases  are  poor  subjects  for  the  Weir 
Mitchell  method,  mainly  because  the  seclusion  is  harmful.  Cases  of 
physical  prostration  from  absolute,  nat  relative,  overwork,  are  also 
good  subjects  for  the  method  and  respond  readily  to  it. 

The  chief  features  of  this  method,  as  employed  by  the  author, 
ar3:  complete  removal  from  accustomed  scenes  and  associates  and  rest 
in  bed  under  the  care  of  a  specially  trained  nurse,  who  screens  the 
patient  from  all  communication  with  her  friends  for  a  definite  period, 
usually  at  least  four  weeks.  During  the  first  two  or  three  weeks  the 
patient  remains  at  absolute  rest  in  bed,  though  she  may  rise  to  attend 
the  calls  of  nature  in  all  but  the  most  rigidly  treated  cases.  Massage 
is  given  daily  in  the  morning.  In  the  afternoon  general  galvanic 
stimulation  is  applied,  preceded  by  the  local  electric  treatment  to  the 
pelvis  or  to  the  stomach  which  may  be  indicated  in  the  particular 


BOEDEK-LIXE    BETWEEX    GYNECOLOGY    AND    XEUBOLOGT.         203 

case,  and  which  is  often  so  important  when  there  is  evidence  of  a 
reflex  origin  of  the  nervous  symptoms. 

The  diet  during  this  time  is  carefully  specified,  beginning  with 
milk  alone,  1  quart  per  diem,  during  the  first  seven  days,  to  which 
toasted  bread  is  added  at  meal-times  in  some  cases.  During  the  second 
week  koumiss  is  taken  between  meals  and  cocoa  replaces  the  milk  at 
breakfast  and  supper.  In  the  third  week  full  diet  may  be  given,  fol- 
lowed by  3  to  5  drops  of  freshly-prepared,  chemically-pure  nitrohydro- 
chloric  acid  in  3  ounces  of  water  after  meals,  the  koumiss  being  con- 
tinued between  meals. 

The  getting-up,  which  begins  at  the  end  of  the  third  or  fourth 
week,  should  be  very  gradual, — at  first,  a  half-hour,  once  a  day,  in- 
creasing a  half-hour  each  day. 

After  the  patient  completes  her  getting-up  she  continues  the 
general  electric  treatment  for  a  time  longer,  depending  on  the  case, 
requiring  an  hour^s  rest  after  each  daily  application,  and  receives  static 
insulation  and  breeze  from  a  powerful  machine  in  the  other  half  of 
the  day  in  place  of  massage. 


CHAPTER  XIV. 
Xeurasthexia  and  Nervous  Prostration. 

Neurasthenia,  or  the  American  disease,  first  described  by  the 
late  George  M.  Beard,  to  whom  American  physicians  owe  the  rescue  of 
electro-therapeutics  from  the  blighting  effects  of  quackery,  has  since 
been  the  subject  of  much  study  and  many  treatises  in  several  lan- 
guages, as  physicians  the  world  over  recognized  that  its  occurrence  was 
by  no  means  limited  by  political  boundaries,  nor  even  by  the  existence 
of  the  environments  of  a  new  country.  That  it  is  peculiarly  a  disease 
of  modern  civilization,  even  though  described  to  some  extent  by 
Burton  in  his  "Anatomy  of  Melancholy,"  published  in  1631,  is  but 
another  way  of  saying  that  it  is  one  of  the  penalties  of  that  evolu- 
tionary development  under  which  society  is  continuously  progressing. 

Of  the  exact  nature  of  neurasthenia  several  views  are  current,  the 
most  reasonable  being  that  it  is  a  symptomatic  manifestation  of  an 
imperfect  performance  of  all,  or  nearly  all,  of  the  organic  functions  of 
the  animal  life,  causing  perversion  of  the  nutrition  and  functionation 
of  the  nervous  system.  Though  it  may  be  caused  by  a  sudden  mental 
shock,  such  a  causation  is  unusual,  and  the  cases  in  which  it  occurs 
are  more  nearly  related  to  hysteria.  The  assumption  that  excessive 
occupation  due  to  the  claims  of  business  or  society  is  a  frequent  cause 
is  but  relatively  true,  for  in  a  normal  condition  it  is  not  work,  but 
worr\^,  that  tells  hardly  upon  the  individual.  In  the  abnormal  con- 
ditions of  alimentation  and  excretion,  which'  are  probably  the  primary 
cause  of  neurasthenia,  a  persistence  in  any  occupation  requiring  a  high 
grade  of  mental  work  or  irregular  hours  becomes  a  persistence  in  rela- 
tive overwork,  though  the  same  exertions  may  be  harmless  under 
more  normal  conditions. 

The  view  that  assigns  the  many  functional  derangements  of  the 
nervous  system  comprised  in  neurasthenia  to  an  autointoxication  due 
to  an  imperfect  performance  of  the  abdominal  functions  is  gaining 
ground,  and  is  evidenced  by  the  recognition  of  lithemia,  in  many 
cases,  in  association  with  the  nervous  symptoms. 
(204) 


NEURASTHENIA.  205 

An  enumeration  of  the  symptoms  of  neurasthenia  would  occupy 
more  space  than  is  available  in  a  work  of  this  nature.  Considered  as  a 
whole,  the  subjective  symptoms  usually  display,  in  a  most  varied  way, 
a  more  or  less  pronounced  inability  to  perform  with  personal  satisfac- 
tion the  various  tasks  imposed  upon  the  individual  by  the  necessities 
of  a  social  existence.  Of  objective  symptoms  the  most  pronounced  are 
due  to  disordered  action  of  the  sympathetic  system  of  nerves,  dis- 
ordered circulation,  and  general  metabolic  sluggishness. 
•  In  the  treatment  the  main  purpose  should  be  to  arouse  the 
defective  activities  of  the  sympathetic  and  of  the  organs  under  its 
control.  The  effectiveness  of  peripheral  applications,  such  as  the  cold 
bath  of  momentary  duration  or  applications  of  static  electricity,  in 
restoring  circulatory  and  nutritive  control,  is  no  argument  against  the 
abdominal  origin  of  the  malady,  as  these  agencies  exert  powerful 
afferent  effects  on  the  sympathetic  ganglia  as  well  as  upon  the  cerebro- 
spinal centres  of  innervation.  Of  this  nature  are  also  massage  and 
electro-motor  stimulation  of  the  limbs  and  body-surface,  with  the 
added  advantage  of  a  stimulation  of  the  local  circulation,  nutrition, 
and  tissue-metabolism;  but,  unless  the  abdominal  sympathetic  system 
is  directly  reached,  the  worst  of  these  cases  will  fail  of  complete 
remedial  alleviation,  and  dissatisfaction  will  result  to  both  patient 
and  ph3^sician. 

Eest  and  regulation  of  the  diet  added  to  these  peripheral  stim- 
ulations will  do  much  for  some  of  these  cases,  but  will  be  lamentably 
ineffective  in  others.  The  importance  of  rest  alone  has  been  enor- 
mously overrated  of  late,  so  much  so,  indeed,  that  hundreds  of  patients 
who  have  done  nothing  but  rest  all  their  lives  are  put  through  a  costly 
treatment  by  their  physicians  under  an  inordinate  belief  in  this  shib- 
boleth, only  to  find  their  neurasthenic  symptoms  made  worse  by  the 
burdensome  effect  of  temporary  additions  of  fat,  or  their  hypochon- 
driac symptoms  intensified  by  a  prison-like  confinement.  In  Phila- 
delphia alone  a  number  of  such  cases  have  leaped  from  their  bed-room 
windows.  The  fact  that  partial  rest  each  day  away  from  home  and 
under  the  surroundings  of  a  well-regulated  sanatorium  is  a  most  valu- 
able portion  of  the  treatment  will  not  make  rest  at  the  patient's  home 
or  in  a  boarding-house  of  equal  effect.  Shorn  of  its  institutional  set- 
ting, change  of  surroundings,  and  the  expectancy  that  occurs  when  a 
number  of  such  cases  are  treated  together,  this  feature  of  the  treat- 
ment is  as  often  hannful  as  useful.     Eest  and  surface  treatment  in 


20G  DISEASES    OF    WOMEN. 

lounge-ridden  cases  are  mnch  like  certain  farming  observable  in 
neglectful  sections  of  the  country  where  the  surface-scratching  of 
superficial  farming  fails  to  supplement  the  fallow  rest  in  producing 
good  crops.  In  neurasthenia  the  causal  conditions  should  be  stirred 
from  the  foundation  by  appropriate  medication  and  applications  to 
the  abdominal  sympathetic.  Electricity  applied  directly  to  the 
abdominal  organs  is  a  most  valuable  means  of  accomplishing  this,  and 
it  should  be  supplemented  by  appropriate  doses  of  exercise  as  well  as 
rest, — the  rest  to  follow  each  dose  of  electricity  or  mechanical  exercise. 

Electricity  has  been  used  for  years  in  this  country  in  the  treat- 
ment of  neurasthenia,  but  it  is  to  be"  regretted  that  its  use  has  partaken 
so  largely  of  the  antiquated  Duchenne  methods  as  to  be  closely  analo- 
gous to  the  soil-scratching  style  of  farming  referred  to  and  equally 
imperfect  in  results.  Even  when  retained  in  the  hands  of  the  physi- 
cian or  an  intelligent  assistant  these  methods  are  merely  a  surface 
excitation,  and  fall  far  short  of  the  possibilities  that  have  been  demon- 
strated by  modern  electrotherapy.  Unfortunately,  the  battery  is  often 
relegated  to  the  nurse  under  imperfect  instructions,  which  lessens  still 
further  any  good  results  it  might  give. 

Aside  from  the  assumption  that  an  agent  of  this  nature  can  be 
employed  properly  by  unskilled  persons,  the  fault  of  the  Duchenne 
methods  of  motor  stimulation  in  neurasthenia  are:  too  great  a  reliance 
on  the  limited  value  of  faradic  currents;  the  use  of  electrodes  of  in- 
adequate size  in  the  applications  to  the  trunk,  resulting  in  an  insuf- 
ficient current-density  at  any  point  beneath  the  surface-muscles;  and 
failure  to  apply  currents  of  effective  density  to  the  abdominal  ganglia 
and  viscera. 

The  excellent  results  derived  from  galvanic  currents  of  50  to  150 
milliamperes  in  the  utero-  or  vagino-  abdominal  applications  of  the 
Apostoli  method  first  directed  my  attention  to  the  value  of  large  elec- 
trodes and  considerable  currents  in  these  conditions.  As  a  result  of 
these  gynecic  applications,  an  improved  general  health  is  almost  in- 
variable, which,  though  in  part  due  to  the  control  exerted  over  the 
growth,  must  be  often  largely  due  to  the  necessary  inclusion  of  the 
abdominal  structures  in  the  field  of  the  current.  Almost  as  good 
results  in  the  stimulation  of  the  sympathetic  may  be  gained  by  placing 
the  indifferent  electrode  beneath  the  back,  in  the  shape  of  a  very  large 
wired-cotton  pad,  and  the  active  one,  which  should  be  six  or  seven 
inches  in  diameter,  on  the  abdominal  surface.     A  greater  effect  is 


NEURASTHENIA.  207 

obtained  if  the  active  electrode  is  given  a  circular  motion,  being  lubri- 
cated by  soaping,  as  all  portions  of  the  abdominal  contents  are  thus 
successively  brought  under  powerful  electric  stimulation. 

The  same  pads  are  also  useful  in  the  administration  of  deeply- 
penetrating  faradic  currents,  which  may  follow  the  galvanic  stimula- 
tion and  should  be  primary;  but  time  and  effort  may  be  economized 
by  combining  the  primary  faradic  witti  the  galvanic  after  the  galvanic 
alone  has  been  employed,  as  this  combination  is  peculiarly  powerful 
as  a  motor  stimulant  of  relaxed  muscular  structures  of  all  kinds, 
giving  all  the  attainable  efficiency  of  faradic  currents,  while  the  more 
valuable  galvanic  current-action  is  continued. 

The  applications  to  the  peripheral  motor-sensory  apparatus  are 
also  best  made  by  the  galvanic  current  instead  of  the  faradic,  the 
patient  continuing  to  lie  on  the  large  pad,  while  the  smaller  one, 
which  is  to  be  kept  negative  and  well  soaped  for  lubrication,  is  carried 
over  the  motor  points  of  each  group  of  muscles  of  the  limbs  in  a  labile 
manner,  all  shock  or  unpleasant  sensations  being  avoided  by  the  free 
use  of  the  controller  and  meter,  the  former  permitting  the  current  to 
be  turned  on  after  the  pad  is  in  position  and  off  before  it  is  re- 
moved from  the  limb.  Only  those  muscles  that  are  physiologically 
associated  in  action  should  be  included  in  the  same  upward  and  down- 
ward strokes  of  the  pad.  For  full  particulars  of  the  mode  of  applying 
general  galvanic  stimulation  the  reader  is  referred  to  Chapter  V.  As 
complete  motor  stimulation  of  all  the  voluntary  muscles  is  thus  gained 
as  is  produced  by  the  faradic  current,  with  a  greater  stimulation  of  the 
peripheral  nerves  and  tissue-metabolism.  The  sense  of  exhilaration  is 
more  marked  than  with  the  faradic  current,  and  greater  warmth  of  the 
extremities  is  produced. 

With  scientifically  applied  currents  as  the  principal  feature  of  the 
treatment,  other  measures  are  conjoined  as  required,  including  mass- 
age if  the  bodily  condition  is  much  below  normal,  rest  for  an  hour 
after  each  treatment,  nitrohydrochloric  acid  if  the  liver  is  sluggish,^ 
and  possibly  a  gentle  laxative  for  a  time.  In  many  cases  thus  treated 
the  diet  requires  but  little  attention,  for,  above  all  things,  we  should 
not  pamper  the  stomach,  but  rather  whip  it  into  obedience.  The  final 
result  is  apt  to  be  a  far  more  lasting  acquisition  of  healthy  blood  and 


^  I  believe  that  the  freshly-prepared  C.  P.  XHCl  acid  has  a  far-reachinc 
eflfect  in  lithemic  conditions,  independently  of  a  sluggish  liver. 


208  DISEASES    or    WOMEN. 

flesh  than  if  the  main  features  of  the  treatment  were  rest  and  over- 
feeding alone. 

In  some  cases,  however,  where  the  nutrition  is  decidedly  at  fault, 
absolute  rest  may  be  used  with  great  advantage  for  a  time  in  connec- 
tion with  the  other  remedies,  but,  if  the  electric  treatment  be  of  the 
kind  described,  the  duration  of  absolute  rest  need  not  be  greater  than 
two  weeks,  to  be  followed  by  two  or  four  weeks  of  the  electric  treat- 
ment under  the  rest-and-exercise  plan  before  the  patient  returns  to  the 
active  affairs  of  life. 

The  value  of  this  modification  of  the  "rest  cure"  has  been  attested 
by  a  number  of  years'  successful  employment  without  a  single  failure, 
though  previous  experience  with  the  rest-and-overfeeding  method  re- 
sulted in  a  number  of  partial  failures  to  permanently  cure  the  patient. 

Another  most  valuable  systematic  treatment  of  neurasthenia  is 
that  by  static  insulation,  the  static  breeze,  and  light  sparks  drawn 
from  the  most  affected  portions  of  the  body.  This  method  is  specially 
recommended  by  Vigoroux,  and  probably  acts  by  a  general  vasomotor 
and  metabolic  stimulation.  Recovery  is  often  indicated  by  an  in- 
creased perspiration  under  treatment,  particularly  in  cases  that  pre- 
sented a  suppression  of  this  excretion.. 

On  re-entering  active  life  the  former  patient  should  remember 
that  her  indisposition  was  not  one  that  had  been  acquired  accidentally, 
but  was  the  result  of  an  imperfect  response  of  the  vegetative  life  to  the 
particular  environment;  and  while  a  continuance  of  the  accustomed 
mental  efforts  may  be  conducive  to  a  healthy  will-power,  nature  ad- 
monishes her  to  seek  a  broader  physical  life,  and  to  minimize  the 
effects  of  artificial  surroundings  by  spending  a  larger  portion  of  each 
year  in  closer  communion  with  itself. 


CHAPTER  XV. 

Institutional  Treatment. 

The  importance  of  electricity  as  the  chief  therapeutic  agent  in 
the  management  of  the  neuroses  and  of  many  chronic  disorders  of  an 
organic  nature;  its  close  association  with  massage,  seclusion  from 
accustomed  environment,  and  other  features  of  the  rest-cure  method; 
together  with  the  necessity  for  costly  equipment  and  special  facilities 
for  the  application  of  strong  currents  in  certain  physical  diseases, 
render  some  mention  of  institutional  treatment  specially  appropriate 
to  these  pages. 

The  practice  of  medicine  is  on  the  eve  of  evolutionary  changes  of 
vast  magnitude.  Closely  associated  with  witchcraft,  divination,  and 
the  black  art  in  past  ages,  it  has  not  been  wholly  emancipated  from 
superstition  even  in  the  present  century,  in  spite  of  a  progress  greater 
than  the  combined  achievements  of  all  preceding  ages,  for  this  progress 
has  been  largely  confined  to  investigations  as  to  the  causation  and  ac- 
curate recognition  of  disease,  and  its  cure  by  surgical  methods,  leaving 
the  extension  of  knowledge  relating  to  the  cure  of  disease  by  medical 
methods  in  a  less  advanced  condition.  The  reason  for  this  can  only 
be  the  vast  difference  in  the  facilities  offered  for  good  work  in  these 
several  departments,  both  in  Europe  and  this  country.  In  the  leading 
European  countries  the  governments  directly  foster  and  support  inves- 
tigations relating  specially  to  diagnosis,  and  in  both  Europe  and 
America,  particularly  in  the  latter,  numerous  hospital  establishments 
favor  the  development  of  surgical  art. 

The  absolute  necessity  of  hospitals  for  good  surgery,  and  the  ease 
with  which  charitable  institutions  may  be  made  available  for  this 
work,  has  resulted  in  a  one-sided  development  of  these  establishments, 
which  has  rendered  them,  at  times,  of  but  little  service  to  purely 
medical  art. 

And  there  are  many  reasons  why  this  should  be  so.  A  well- 
ordered  charity  hospital  may  do  ideal  work  in  surgery,  for  the  master- 
hand  itself  may  do  the  brief  work  that  makes  for  success  or  failure, 

"  (209) 


210  *  DISEASES    OF    WOMEN. 

leaving  unessential  details  to  less  skilled  hands;  but  the  medical  treat- 
ment of  a  charity  case,  in  its  best  and  most  complete  form,  can  rarely 
be  administered  by  the  chief  physician  without  a  far  greater  sacrifice 
of  time  than  he  is  able  to  make.  This  results  in  the  whole  machinery 
of  the  hospital  being  developed  in  a  surgical  direction,  leaving  it  but 
imperfectly  adapted  for  the  treatment  of  any  medical  cases  other  than 
those  acutely  ill,  or  in  whose  cases  the  mere  administration  of  drugs 
is  sufficient. 

The  charity  hospitals  have,  therefore,  been  of  but  small  value  in 
the  development  of  remedial  arts  as  applied  to  the  cure  of  non-surgical 
chronic  ailments,  for,  in  spite  of  a  full  appreciation  of  the  value  of 
drugs  in  this  class  of  affections,  it  is  not  overstating  the  bare  truth  to 
say  that  they  are  of  but  little  use.  It  is  to  natural  forces  and  other 
physical  agencies,  carefully  selected  and  applied  by  skilled  specialists, 
that  we  must  look  for  therapeutic  advances  that  shall  be  commen- 
surate with  similar  advances  in  allied  fields,  and  that  this  may  be  done 
it  is  absolutely  necessary  that  special  institutions  be  created  for  this 
particular  purpose.  It  is  but  a  remnant  of  superstition  to  rely  upon 
advice  and  prescriptions  when  the  whole  environment  of  the  patient 
needs  remedial  adaptation;  and  this  remedial  adaptation  can  only  be 
employed  with  adequate  means  and  adequate  appliances. 

Special  institutions,  thoroughly  adapted  to  particular  lines  of 
work,  are,  therefore,  a  most  necessary  adjunct  to  modern  medical 
progress,  and  the  author  looks  forward  to  the  time  when  their  value 
will  be  as  well  appreciated  by  the  profession  in  all  chronic  affections 
as  the  modern  hospital  is  appreciated  as  a  means  for  good  surgery. 
That  the  people  for  whose  benefit  they  will  be  created  already  under- 
stand the  value  of  institutional  treatment  is  shown  by  the  success  of 
institutions  now  well  patronized  by  them,  some  of  which  were  estab- 
lished by  uneducated  persons. 

When  this  desirable  improvement  in  the  care  of  the  non-surgical 
sick  has  been  fully  established,  we  will  no  longer  be  so  inconsistent 
and  untrue  to  ovir  work  as  to  present  the  spectacle  daily  witnessed  of 
a  physician  prescribing  mere  drugs  for  well-to-do  patients  in  a  back 
parlor  in  the  morning,  which  is  bare  of  remedial  appliances  for  the 
proper  treatment  of  the  persons  who  pay  him  for  the  highest  expres- 
sion of  his  art,  and  in  the  afternoon  catering  to  paupers  in  the  splen- 
dors of  a  perfectly-appointed  hospital.  If  the  hospital  facilities  add 
to  the  welfare  of  the  charity  patient,  surely  institutional  facilities  are 


INSTITUTIONAL    TREATMENT.  21] 

equally  useful  to  the  more  deserving  citizen.  In  reality  there  is  a 
greater  necessity  for  well-equipped  work  in  battling  with  the  ailments 
of  intellectual  beings^,  aside  from  the  moral  obliquity  of  a  civilization 
that  reserves  its  best  services  for  its  defective  classes. 

The  value  of  institutional  facilities  is  particularly  great  in  the 
practice  of  electro-therapeutics,  owing  to  the  magnitude  of  the  instru- 
mental equipment  required  and  the  necessity  for  certain  classes  of  ap- 
plications being  performed  under  such  circumstances  that  the  patient 
may  rest  in  bed  immediately  afterward.  It  also  permits  of  a  closer 
attention  to  details  on  the  part  of  the  chief  physician,  through  an 
economy  of  his  time,  and  makes  it  convenient  to  associate  with  the 
main  element  of  treatment  other  remedial  agencies  of  great  service 
in  this  class  of  cases,  such  as  scientific  massage,  radiant  heat-baths, 
good  nursing;  regulation  of  dietary,  rest,  and  exercise;  and  the 
mental  medicines  of  discipline,  expectancy,  and  environment. 


CHAPTEK  XVI. 

Materxal  Sterility  and  Impotence. 

Aside  from  congenital  deficiencies  and  anomalies  of  development 
of  the  essential  organs  of  generation,  we  have  been  taught,  since  the 
days  of  Marion  Sims,  that  the  chief  reason  for  sterility  attributable  to 
the  woman  is  narrowness  or  flexion  of  the  uterine  canal.  "When  it  is 
remembered  that  the  narrowest  pin-hole  os  will  admit  a  sound  on 
careful  manipulation  which  is  many  times  larger  than  the  self-pro- 
pelling spermatozooid  it  would  seem  that  this  reasoning  is  incon- 
clusive. It  is  doubtless  to  the  operative  furor  that  the  popularity  of 
the  stenosis-and-atresia  theory  of  sterility  is  due,  for,  since  the  days  of 
Sims  and  J.  Y.  Simpson,  practically  no  form  of  treatment  has  been 
employed  except  some  method  of  enlargement  of  the  canal.  This  was 
at  first  accomplished  by  slitting  the  cervix,  producing  artificially,  in 
other  words,  the  same  lesion  for  the  sewing  up  of  which  other  costly 
operations  were  later  devised.  Owing  to  the  combined  ineffectiveness, 
morbidity,  and  mortality  of  this  procedure,  it  has,  of  late,  been  super- 
seded by  so-called  "dilatation,"  which  is  accomplished  only  by  tearing 
apart  the  muscular  and  fibrous  tissues  that  encircle  the  canal  by 
powerful  steel  instruments.  Only  exceptionally  has  this  accomplished 
a  cure  of  the  sterility,  while  it  is,  at  times,  followed  by  serious  con- 
sequences in  the  shape  of  parametritis  and  diseased  appendages.  One 
case  of  ectopic  pregnancy  and  a  number  of  instances  of  uterine  and 
ovarian  tenderness  have  been  observed  by  me  after  dilatation  for  this 
purpose  in  patients  who  were  free  from  tenderness  previously. 

Far  more  prominent  causes  of  sterility  may  be  found  in  imperfect 
participation  of  the  uterus  in  the  sexual  orgasm,  catarrhal  changes  in 
the  mucus  of  the  uterus  and  tubes,  and  inactive  ovaries, — the  last  two 
being  the  most  important.  A  lessened  aspiratory  action  of  the  uterus, 
while  rendering  conception  less  certain,  cannot  be  a  serious  impedi- 
ment, on  account  of  the  automobile  powers  of  the  spermatozooids. 
This  defect  may,  however,  be  materially  lessened  by  the  general  intra- 
pelvic  action  of  electricitv.  promoting  the  nerve-tone  of  the  organs, 
(212) 


STERILITY    AND    IMPOTENCE.  213 

particularly  of  the  uterus  and  ovaries;  increasing  muscular  contrac- 
tility; and  quickening  circulation.  The  method  best  adapted  to, 
accomplish  this  purpose  is  the  vagino-abdominal  galvanic  application 
with  covered  vaginal  electrode,  which  should  be  negative,  a  current  of 
30  to  40  milliamperes  being  turned  on  and  off,  gradually  and  re- 
peatedly, by  the  swelling  method.  This  may  be  supplemented  with 
labile  lumbar  applications  of  the  galvanic  current  to  the  sexual  centre 
of  the  cord,  the  patient  lying  upon  the  face  with  a  large  pad  under  the 
abdomen. 

Of  the  toxic  effect  of  altered  uterine  secretions  on  the  fertilizing 
cells  of  the  semen  there  can  be  no  question,  and  it  is  in  these  cases  that 
galvanic  electricity  applied  within  the  cavity  of  the  uterus  is  of  the 
greatest  service  by  its  alterative  action  on  the  secreting  surface. 
Unless  the  intra-uterine  treatment  is  indicated,  also,  by  marked 
changes  in  the  mucous  membrane,  the  covered  elastic  electrode  is 
best  as  promoting  favorable  changes  in  the  mucous  membrane  with 
least  traumatism.  It  has  been  my  habit  to  employ  the  positive  pole 
usually,  though  the  choice  of  pole  for  this  purpose  is  open  to  further 
investigation  to  determine  whether  the  normal  alkalinity  of  the 
uterine  mucus  should  be  increased  by  the  negative  pole  or  diminished 
by  the  positive  pole.  Possibly  neither  effect  is  important,  the  results 
depending  rather  on  the  simple  excitation  of  a  more  normal  secretion. 

Deficient  activity  of  the  ovaries  can  only  be  inferred  as  a  cause  of 
sterility  in  the  absence  of  any  demonstrable  lesion  or  more  patent 
defect  of  functionation  on  the  part  of  the  woman,  and,  of  course,  after 
the  question  of  the  possible  sterility  of  the  husband  has  been  elim- 
inated. It  may  or  may  not  be  associated  with  lack  of  sexual  appetence 
and  responsiveness,  for  many  women  conceive  readily  in  whom  the 
orgasm  is  deficient  or  absent.  Any  method  of  treatment  that  pro- 
motes increased  activity  of  the  pelvic  circulation,  such  as  negative 
vagino-abdominal  applications  of  either  current,  may  increase  ovula- 
tion, while  the  musculo-tonic  effect  of  the  galvanic  current  turned  on 
in  the  swelling  manner  repeatedly  may  do  much  to  lessen  a  practical 
maternal  impotence  from  weakened  musculation,  which  is  only  less 
disastrous  to  the  conjugal  relation  than  similar  conditions  in  the  male. 

But  few  instances  of  this  affection  have  been  placed  under  my 
care  for  the  purpose  of  curing  the  sterility, — but  five  in  all.  in  four  of 
which  the  treatment  was  successful  at  some  time  during  a  year  follow- 
ins:  the  cessation  of  the  treatment,  two  instances  beins:  almost  imme- 


214  DISEASES    OF    WOMEN. 

diate.  In  one  case  that  was  a  failure  up  to  the  date  of  her  last  report 
to  me  the  ovaries  were  both  prolapsed  and  the  tubes  also  probably 
involved  in  the  remnants  of  an  old  pelvic  inflammation.  Her  sympto- 
matic condition  was,  nevertheless,  improved. 

The  slight  attention  paid  to  this  subject  is  doubtless  due,  in  part, 
to  a  lack  of  information  as  to  the  value  of  this  method  and,  in  part,  to 
the  prevalent  disinclination  of  American  women  for  the  burdens  of 
maternity.  That  electricity  may  cure  sterility  when  the  patient  only 
asks  that  the  pelvic  pain  of  uterine  inflammation  be  cured  is  shown 
by  the  table  on  pages  38-i-87,  where,  of  thirty-two  cases  of  uterine 
disease  that  involved  at  least  temporary  or  acquired  sterility,  eight 
had  become  pregnant  after  the  treatment  when  my  report  was  made 
(September,  1894).  In  a  paper  by  Apostoli  read  at  the  same  meeting 
of  the  American  Electro-Therapeutic  Association,  as  many  as  eighty 
cases  were  recorded  as  having  become  pregnant  after  intra-uterine 
electric  treatment,  some  of  them  having  conceived  shortly  after  one 
application.  Apostoli  does  not  mention  how  many  of  his  cases  were 
nulliparous  after  some  years  of  marriage  and,  therefore,  sterile,  but 
of  the  twenty-two  cases  reported  in  extenso  in  the  paper,^  five  were 
nulliparas.  An  interesting  case  of  prolonged  hemorrhagic  metritis  in 
a  nullipara,  the  cure  of  which  was  followed  by  pregnancy,  is  detailed 
on  page  83. 


'Transactions  of  the  American  Electro-Therapeutic  Association,  page  371, 
1894. 


CHAPTER  XVII. 

Ectopic  GtEstation  and  Obstetrics. 

Ectopic  Gestation.— This  accident,  which  has  been  proven  of  late 
to  be  of  considerable  frequency  both  by  the  records  of  carefully  con- 
ducted post-mortem  examinations  and  the  experience  of  surgeons,  is 
probably  even  more  frequent  in  occurrence  still,  as  many  cases  doubt- 
less recover  after  extraperitoneal  rupture  without  the  diagnosis  having 
been  made. 

It  is  beyond  the  scope  of  this  work  to  enter  into  a  full  discussion 
of  the  etiology  and  natural  history  of  ectopic  gestation,  since  the  value 
of  electricity  as  a  sole  or  principal  remedy  is  confined  to  a  certain 
stage  of  gestation  only, — namely,  from  conception  to  the  end  of  the 
fourth  month,  after  which  time  the  consideration  of  the  affection 
belongs  exclusively  to  the  surgeon.  During  these  early  months,  never- 
theless, the  electric  treatment  is  clearly  the  method  of  choice,  since  it 
has  been  established  by  many  competent  observers  that  at  this  time 
the  ovum  may  be  devitalized  and  its  complete  absorption  secured  by 
this  means,  without  subjecting  the  patient  to  the  dangers  and  uncer- 
tainties of  abdominal  section. 

Lawson  Tait's  classification  of  ectopic  pregnancy,  which  is  gener- 
ally received,  is  as  follows: — 

I.  Ovarian,  possible,  but  not  proved. 
II.  Tubal,  in  free  part  of  tube,  is 

(a)  Contained  in  tube  up  to  fourteenth  week,  at  or 
before  which  time  primary  rupture  occurs,  and 
then  progress  of  gestation  is  directed  into 
(&)  Abdominal  or  intraperitoneal  gestation;  uniformly 
fatal  (unless  removed  by  abdominal  section),  pri- 
marily by  hemorrhage,  secondarily  by  suppuration 
of  the  sac  and  peritonitis, 
(c)  Broad  ligament,  or  extraperitoneal,  gestation,  which 

(215) 


216  DISEASES    OF    WOMEN. 

(d)  May  develop  in  broad  ligament  to  full  term  and  be 

removed  at  viable  period  as  living  child. 

(e)  May  die  and  be  absorbed  as  extraperitoneal  hema- 

tocele. 

(f)  May  die  and  suppurating  ovum  be  discharged  at  or 

near  umbilicus,  or  through  vagina,  bladder,  or  in- 
testinal tract. 

(g)  May  remain  quiescent  as  lithopedion. 

(h)  May  become  abdominal  or  intraperitoneal  gestation 
by  secondary  rupture. 
III.  Tubo-ovarian,  or  interstitial,  is  contained  in  part  of 
tube  embraced  by  uterine  tissue,  and,  so  far  as  is 
known,  is  uniformly  fatal,  by  primary  intraperi- 
toneal rupture  (as  h),  before  fifth  month. 

From  this  it  will  be  seen  that  the  question  of  electric  treatment 
is  concerned  only  with  Class  II  (a),  unruptured  tubal  pregnancy 
before  the  fourteenth  or  sixteenth  week,  and  with  the  same  condition 
after  early  rupture  into  the  broad  ligament,  where  it  continues  to 
develop,  as  in  II  (d).  Tubal  pregnancy  is,  by  far,  the  most  frequent 
form,  and  its  early  diagnosis  becomes,  therefore,  a  matter  of  great  im- 
portance, though  attended  with  much  difficulty.  Indeed,  the  possi- 
bility of  diagnosis  before  primary  rupture  of  the  sac  into  the  broad 
ligament,  which  occurs  at  about  the  fourteenth  week,  has  been  denied 
by  some  authorities,  yet  a  reasonably  certain  diagnosis  has  been  made 
by  both  surgeons  and  electro-therapeutists  in  many  instances  of  late, 
some  of  them  of  sufficient  certainty  to  warrant  the  surgical  removal 
in  the  absence  of  proper  electric  treatment  and  all  of  them  certain 
enough  to  warrant  the  electric  treatment,  which  would  be  equally 
applicable  to  most  of  the  conditions  for  which  it  could  be  mistaken. 
And  herein  lies  one  of  the  two  chief  advantages  of  electricity  at  this 
stage  of  ectopic  gestation.  Given  a  reasonable  presumption  that  the 
case  is  one  of  tubal  or  intraligamentous  pregnancy,  the  physician  is 
not  compelled  to  take  the  horrible  responsibility  of  counseling  a  pos- 
sibly unnecessary  unsexing  operation  in  a  young  wife,  but,  with  a  full 
recognition  of  the  possible  gravity  of  the  case,  may  subject  her  only 
to  the  discom.fort  of  absolute  rest  in  hed  for  one  or  more  months,  and 
daily  applications  of  a  method  that  will  kill  the  fetus  if  one  be  present, 
and  subsequently  promote  absorption  of  the  ovum  and  surrounding 


ECTOPIC    GESTATION    AND    OBSTETRICS.  217 

congestion,  and,  if  the  case  is  not  one  of  ectopic  gestation  but  a  sud- 
denly enlarged  tube  from  inflammatory  congestion,  an  ovaritis,  or  a 
small  fibroid,  will  be  equally  efl'ective  in  arresting  progress  and  con- 
tributing to  a  future  cure.  The  laudable  object  of  verifying  the  diag- 
nosis is  secondary  to  the  best  interests  of  the  patient,  and  in  this  case 
the  patient's  true  interests  point  to  the  avoidance  of  the  operation  if 
the  trouble  can  be  cured  without  it,  whether  its  true  nature  is  ever 
proved  or  not. 

The  selection  of  electricity  as  the  appropriate  treatment  is  nar- 
rowed down,  as  before  stated,  to  two  stages  in  tubal  pregnancy:  (1) 
before  rupture  into  broad  ligament  at  or  about  the  fourteenth  week; 
(2)  after  rupture  into  broad  ligament. 

Diagnosis  of  Tubal  Pregnancy  Before  Rupture. — Unfortunately, 
there  are  too  often  no  symptoms  to  alarm  the  patient,  or  even  to  cause 
her  to  suspect  pregnancy,  until  the  onset  of  primary  rupture  of  the 
sac  into  the  tube,  and  this  is  not  so  surprising,  when  it  is  remembered 
that  no  small  proportion  of  cases  occur  in  those  newly  married,  and 
therefore  unfamiliar  with  the  subjective  symptoms  of  pregnancy,  and 
in  others  who  have  been  sterile  so  long  as  not  to  be  looking  for  such  a 
contingency.  Such  cases,  moreover,  are  liable  to  have  long  felt  some 
discomfort  in  the  pelvis  from  latent  catarrhal  disease  of  the  uterus  or 
tubes,  which  is  possibly  an  important  etiologic  factor  in  the  arrest 
of  the  ovum  in  the  tube.  The  symptoms  at  this  stage,  if  any  be  noted, 
are  likely  to  be  those  of  a  normal  pregnancy,  usually  accompanied  by 
a  continuance  or  even  more  frequent  and  abundant  menstruation.  More 
positive  symptoms  may,  however,  cause  the  patient  to  consult  her 
physician,  and  these  are  the  colicky  paroxysms,  attributed  by  Parry  to 
contractions  of  the  cyst.  By  others  they  have  been  attributed  to 
minute  hemorrhages.  More  likely  they  are  merely  the  neuralgic  ex- 
pression of  an  unaccustomed  and  growing  tension  of  the  tube,  the 
universal  habit  of  sensory  nerves  being  the  explosive  expression  of  a 
continuous  tension  or  irritation.  While  the  habit  of  examining  all 
women  in  the  early  months  of  even  supposedly  normal  pregnancy 
should  be  aimed  at  as  a  routine  measure,  the  physician  should  in- 
variably make  an  examination  by  touch  when  pain  of  this  nature  is 
complained  of. 

On  bimanual  examination,  which,  in  a  suspected  case,  should 
be  as  gently  conducted  as  is  consistent  with  a  thorough  mapping  out 
of  the  pelvic  contents,  a  soft,  elastic,  semifluctuating  tumor  will  be 


218  DISEASES    OF    WOMEN. 

found  in  the  region  of  the  tube,  on  one  or  otlier  side  of  the  fundus, 
corresponding,  in  size,  to  the  development  of  the  ovum.  This  mass 
is  quite  evidently  cystic  to  the  educated  touch  and  is  usually  more 
tender  than  any  other  cystic  tumor  with  which  it  can  be  confounded. 
The  cervix  will  present  the  softening  peculiar  to  pregnancy,  but  the 
uterus  will  be  found  to  be  smaller  than  it  should  be  at  a  correspond- 
ing period  of  normal  pregnancy. 

Such  are  the  presumptive  signs  of  a  tubal  pregnancy  prior  to 
rupture.  Though  abdominal  sections  have  been  performed  on  the 
strength  of  diagnoses  so  arrived  at,  and  the  condition  at  times  veri- 
fied, there  is  grave  reason  to  doubt  that  the  diagnosis  can  be  suffi- 
ciently certain  before  operation  to  warrant  so  extreme  a  measure. 
Indeed,  cases  have  been  recently  reported  where  the  finding  of  slight 
traces  of  bloody  serum  near  the  tube  was  accepted  by  the  operator 
as  justifying  the  operation,  even  when  no  other  evidence  of  the  ovum 
could  be  found.  Fortunately,  these  views  were  combated  at  a  meet- 
ing of  the  New  York  Obstetrical  Society  by  Dr.  A.  Palmer  Dudley,^ 
who  explained  that  similar  conditions  had  been  found  by  him  in 
operations  during  menstruation  in  the  absence  of  any  kind  of  preg- 
nancy. The  gravity  of  the  conclusions  that  lead  a  surgeon  to  per- 
form a  dangerous  operation  resulting  inevitably  in  castration  on  a 
young  wife  of  a  few  weeks  or  months  is  by  no  means  slight,  and 
when  this  grave  risk  and  abhorrent  results  are  deliberately  preferred 
to  electric  treatment,  with  the  abundant  testimony  in  its  favor  at 
this  stage  of  the  disease,  the  conduct  of  the  surgeon  savors  of  mal- 
practice, and  should  be  condemned  by  all  honest  physicians.  And 
this  may  even  be  said  of  a  case  where  the  presumptive  evidence  of 
an  unruptured  tubal  pregnancy  is  very  strong,  as  there  is,  at  this 
stage,  no  reason  whatever  why  complete  absorption  should  not  follow 
electric  feticide,  permitting  the  tube  even,  and  surely  the  ovary,  to 
be  subsequently  brought  into  a  healthy  condition  under  vaginal 
applications. 

There  is,  on  the  contrary,  no  contra-indication  to  electricity 
whether  the  diagnosis  be  certain  or  uncertain.  If  it  is  a  case  of 
tubal  pregnancy  it  may  be  cured  in  this  way.  If  it  be  not,  no 
harm  is  done  by  the  treatment,  which  may  even  be  equally  adapted 
to  tlio  actual  diseases  present,  such  as  a  salpingitis  with  exudation. 


^New  York  Gynecological  and  Obstetrical  .Jomnal,  page  109,  July.  1896. 


ECTOriC    GESTATION    AND    OBSTETRICS.  219 

or  a  uon-puruleiit  enlargement  of  the  ovary.  Both  of  these  condi- 
tions are,  in  fact,  relieved  with  such  certainty  by  vagino-abdominal 
galvanic  and  faradic  currents  as  to  frequently  leave  the  physician 
in  doubt  as  to  the  true  nature  of  the  disease;  but  surely  no  sane 
woman  would  wish  an  abdominal  section  to  satisfy  a  scientific  inquiry 
of  no  concern  to  her.  Such  ignorance  can  surely  be  borne  in  con- 
nection with  the  bliss  of  restored  health,  plus  the  retention  of  im- 
portant functions,  when  wisdom  is  purchased  at  such  a  cost. 

Diagnosis  of  Tubal  Pregnancy  At  and  After  Rupture. — After 
rupture  of  the  sac  has  occurred  the  diagnosis  is  far  easier  to  make 
than  before  rupture.  A  sharp,  agonizing  pain  in  the  pelvis,  accom- 
panied by  more  or  less  collapse, — anxious  expression,  fainting,  cold 
and  pallid  skin  bedewed  with  a  cold  perspiration,  and  a  rapid  and 
feeble  pulse  becoming  imperceptible, — betokens  a  rupture  into  the 
peritoneal  cavity  if  an  antecedent  history  of  presumptive  pregnancy 
can  be  obtained  and  the  pelvic  examination  coincides.  The  physical 
signs  of  intraperitoneal  rupture  obtainable  by  touch  are  not  so  well 
marked  as  when  the  rupture  is  into  the  broad  ligament.  The  mass 
at  one  side  of  the  uterus  is  boggy  and  usually  less  in  size  than  pre- 
vious to  rupture.  When  the  rupture  is  into  the  broad  ligament  a 
tense,  exceedingly  painful  tumor  is  found  on  one  side  of  the  uterus, 
usually  pressing  the  latter  to  the  opposite  side  of  the  pelvis. 

To  determine  whether  the  case  is  suitable  for  electricity  or  must 
be  at  once  consigned  to  surgery  it  is  important  to  distinguish  be- 
tween a  rupture  into  the  peritoneal  cavity  or  into  the  broad  liga- 
ment. The  former  produces  the  more  profound  shock  and  collapse, 
and  on  vaginal  examination  a  less  prominent  tumor  is  found.  The 
latter  is  accompanied  by  less  shock  and  presents  a  more  rounded, 
tense,  and  jDrominent  tumor.  In  either  case  a  flow  from  the  uterus 
may  exist,  simulating  abortion,  from  which  it  is  to  be  distinguished 
by  the  smaller  size  of  the  uterus,  the  possibility  of,  at  times,  making 
out  a  sulcus  between  the  tumor  and  the  fundus,  and  finally  by  find- 
ing the  uterus  empty  should  it  be  thought  necessary  to  sound  it. 
Additional  causes  of  error  are  confounding  it  with  rupture  of  another 
viscus,  hematocele  or  hematoma  from  other  causes,  or  a  violent  attack 
of  hysteria. 

Should  the  condition  of  the  patient  indicate  that  the  haemor- 
rhage is  into  the  abdominal  cavity  instead  of  merely  within  the 
lavers  of  the  broad  lio-ament  no  time  should  be  lost  in  havinaf  the 


220  DISEASES    OF    WOMEN. 

abdomen  opened  and  the  bleeding-points  tied  by  a  competent  ab- 
dominal surgeon.  The  whole  question  of  the  use  of  electricity  hinges, 
therefore,  on  the  presence  of  free  bleeding  into  the  abdomen. 

Electric  Treatment. — As  before  remarked,  the  purposes  of  the 
electric  treatment  are  twofold:  to  kill  the  fetus  and  to  cause  its 
absorption.  To  accomplish  the  former  powerful  currents  are  re- 
quired, which  should  always  be  turned  on  gradually  with  the  con- 
troller, and  in  the  case  of  the  galvanic  current  it  is  best  to  employ 
galvanic  alternatives,  the  internal  electrode  being  alternately  posi- 
tive and  negative.  The  current  should  be  turned  on  gradually,  held 
for  two  minutes,  turned  off  gradually,  the  polarity  reversed  without 
removing  the  electrode,  and  the  procedure  repeated  with  the  current 
in  the  opposite  direction.  The  ordinary  vagino-abdominal  method 
(page  56)  is  employed,  a  cotton-covered  vaginal  electrode  being 
pressed  against  the  tumor  in  the  vagina,  with  a  large,  moist,  clay 
pad  or  other  efficient  dispersing-electrode  on  the  abdomen.  Faradic 
currents,  which  should  preferably  be  the  primary  of  a  powerful  coil, 
are  thought  to  be  best  by  some,  and  it  is  therefore  wisest  to  use 
both  currents,  one  after  the  other,  at  least  once  daily  until  the  sac 
shrinks  and  becomes  less  tender.  The  same  treatment  should  then 
be  continued  at  greater  intervals  and  less  dosage  until  absorption 
seems  well  under  way. 

The  galvanic  dosage  should  be  from  100  to  150  milliamperes 
and  the  faradic  to  point  of  endurance,  all  possibility  of  shocks  being 
eliminated,  particularly  if  rupture  into  the  broad  ligament  has  oc- 
curred. 

Dr.  A.  Brothers,  of  Xew  York,  has  made  a  careful  statistical 
study  of  the  cases  reported  in  medical  literature,  and  his  last  paper^ 
on  the  subject  deserves  to  be  quoted  in  full  as  presented  to  the  Amer- 
ican Electro-Therapeutic  Association  in  September,  1893: — 

''First  employed  in  Italy  by  Bachetti  in  1853,  and  later  by 
Braxton  Hicks  in  England  in  1866,  the  electric  method  of  treating 
ectopic  gestation  was  first  resorted  to  on  this  side  of  the  Atlantic 
by  Allen,  of  Philadelphia,  in  1869,  and  has  since  remained  almost 
a  purely  American  plan  of  treatment.  In  the  paper  which  I  wrote, 
five  years  ago,  for  Tlie  American  Journal  of  Ohsfetrics  (May.  1888) 


'  "Present  Position  of  the  Electric  Treatment  of  Extra-uterine  Pregnancy." 
Transactions  of  the  American  Electro-Therapeutic  Association,  page  170.  1893. 


ECTOi'lC    GESTATION    AND    OBSTETRICS.  221 

I  collected  statistics  of  forty-three  cases  treated  by  electricity,  with 
one  death.  In  a  paper  published  two  years  later,  on  the  'Subsequent 
Behavior  of  Cases  Treated  by  Electricity/^  I  found  that  the  twenty- 
five  cases  which  I  had  been  able  to  trace  were  doing  well  after  a 
lapse  of  one  to  eight  years,  and  that  none  of  them  had  been  com- 
pelled to  undergo  secondary  operations.  Many  of  these  patients 
still  carried  traces  of  the  old  trouble,  but  without  perceptible  incon- 
venience. 

"Within  the  last  few  years  the  epidemic  of  laparotomy  fever 
which  originated  in  Europe  has  infected  our  shores  and  spread  over 
our  continent  to  such  an  extent  as  to  temporarily  displace  this  treat- 
ment from  the  position  it  properly  deserves.  As  a  result,  the  litera- 
ture of  the  past  few  years  shows  a  smaller  number  of  cases  published 
than  we  should  expect  from  the  past  success  of  this  treatment, 
although  a  small  band  of  able  practitioners  continue  to  adhere  to 
their  convictions  and  employ  it,  under  judicious  restrictions,  wher- 
ever it  is  properly  indicated. 

"To  bring  this  subject  down  to  the  present  I  have  reviewed  the 
literature  at  my  command,  and  am  thus  enabled  to  present  the  table 
on  pages  224  and  225. 

"I  have  therefore  been  able  to  find  records  of  eighty-five  cases 
of  extra-uterine  pregnancy  in  which  electricity  was  employed  to  de- 
stroy the  fetus.  I  do  not  regard  this  as  a  complete  list,  for  some 
cases  have  been  overlooked  and  others  have  not  been  published.  It 
is  sufficient,  however,  to  show  that  the  method  has  been  pretty  ex- 
tensively employed. 

"In  two  cases  (60  and  61)  the  treatment  apparently  failed  in 
the  hands  of  very  able  men  (Coe  and  Wenning),  but  subsequent  lap- 
arotomy showed  the  diagnosis  to  have  been  faulty,  for  in  both  cases 
the  gestation  was  intra-uterine.  Coe  saved  his  patient  after  she 
aborted,  but  Wenning,  who  had  resorted  also  to  aspiration,  was  un- 
fortunate in  losing  his.  In  Case  81,  that  of  Lewis,  electricity  was 
discarded  and  abdominal  section  performed,  resulting  in  recovery.^ 
In  one  of  Blackwood's  cases  the  extra-uterine  mass  had  shrunk  two 


^  The  American  Journal  of  Obstetrics,   1890,  volume  xxiii,  page   113. 

^  The  cause  for  discarding  electricity  in  Lewis's  patient  was  a  fear  that 
the  case  was  a  normal  pregnancy.  There  was  no  need  of  the  subsequent  lapa- 
rotomy, as  absorption  of  the  fetus  was  partially  complete. — G.  T?.  M. 


222  DISEASES    OF    WOMEN. 

3'ears  later  to  one-half  its  original  size,  and  he  was  in  favor  of 
galvanism  to  further  its  absorption.  The  patient,  however,  was  ad- 
vised by  a  specialist  to  submit  to  laparotomy,  from  which  she  died. 
In  none  of  these  cases  can  the  electric  treatment  be  accused  of  hav- 
ing done  any  harm. 

"Collapse  during  the  administration  of  the  current  has  occurred 
in  the  cases  of  Munde  (23),  Janvrin  (34),  and  Coe  (54);  but  only 
one  case — that  of  Janvrin  (34) — proved  fatal.  In  two  of  Blackwood's 
cases  (70  and  71)  the  symptoms  of  internal  hemorrhage  due  to  partial 
rupture — shock,  faintness,  debility,  etc. — were  present,  but  the  doctor 
writes  me  that  the  cases  made  favorable  recoveries. 

"Aspiration  was  resorted  to  in  three  cases  in  connection  with 
electricity  by  Braxton  Hicks  (2),  Lusk  (30),  and  "Wenning  (61). 
Hicks  and  Wenning  lost  their  patients, — the  latter  supplementing 
the  procedure  by  laparotomy, — but  Lusk  saved  his  case  after  assisting 
the  discharge  of  the  fetus  through  a  vaginal  rent. 

"The  fetus  was  displaced  from  the  tube  into  the  uterine  cavity 
in  five  cases, — those  of  McBurney  (6),  Garrigues  (29),  Blackwood 
(74),  Grandin  (83),  and  Carriker  (84). 

"The  case  of  Landis  (5  and  11)  is  unique  in  that  the  same 
patient  suffered  twice  from  extra-uterine  pregnancy,  but  was  in  each 
instance  successfully  treated  by  electricity. 

"In  "Westcott's  case  (17)  the  extra-uterine  pregnancy  was  asso- 
ciated with  normal  pregnane}',  which  was  not  disturbed  by  the  treat- 
ment, and  Bierwirth's  patient  (52)  was  suffering  from  typhoid  fever 
while  undergoing  the  same  treatment. 

"The  fetus  was  expelled  through  vaginal  or  rectal  rents  in  four 
cases, — those  of  Lusk  (30),  Chadwick  (39),  and  Blackwood  (72  and 
73).     These  patients  ultimately  recovered. 

"Only  one  death — that  of  Janvrin's  patient  (34) — lias  occurred  in 
seventy-eight  cases  in  which  electricity  was  employed  without  puncture, 
and  in  this  case  there  were  marked  symptoms  of  hemorrhage  pre- 
vious to  the  resort  to  electricity. 

"The  nature  of  the  current  used  has  varied.  In  twenty-seven 
cases  faradism  was  used,  in  twenty-five  cases  galvanism,  either  cur- 
rent (not  stated)  in  nine  cases,  both  currents  successfully  in  sixteen 
cases,  galvano-puncture  in  seven  cases,  and  static  electricity  in  one 
case. 

"Of  the  seven  cases  treated  by  electro-puncture,  there  were  five 


ECTOPIC    GESTATION    AND    OBSTETRICS.  223 

recoveries  and  two  deaths.  This  proves  electro-jDuneture  to  be  a 
very  dangerous  method,  the  bad  results  being  undoubtedly  due  to 
the  puncture  and  not  to  the  current.  Similar  bad  results  have  fol- 
lowed the  use  of  simple  puncture  with  aspiration  or  followed  by  the 
injection  of  drugs.  In  my  first  paper  I  referred  to  fourteen  cases 
of  failure  or  death  after  the  use  of  simple  tapping  or  injection  of 
drugs. 

"Although  the  electric  treatment  has  been  chiefly  employed  in 
our  own  country,  my  table  shows  the  interesting  fact  that  it  has  also 
been  used  five  times  in  Eussia,  five  times  in  England,  and  once  in 
Italy,  Canada,  Germany,  France,  and  Australia. 

"It  may  be  interesting  to  quote,  at  this  point,  the  most  recent 
views  of  many  of  the  best  authorities  regarding  this  plan  of  treat- 
ment. Playfair^  says:  'This  practice  is  perfectly  safe,  and  there  can 
be  no  rational  objection  to  its  being  tried.'  Lusk,  in  the  last  edi- 
tion of  his  work  on  'The  Science  and  Art  of  Midwifery'  (New  York, 
1892),  says:  'The  danger  which  threatens  the  life  of  the  patient  is 
often  imminent,  and  assistance  from  afar  is  not  always  easy  to  obtain. 
Under  these  conditions  the  indication  for  treatment  is  plainly  the 
adoption  of  measures  to  destroy  the  life  of  the  fetus,  and  thus,  by 
arresting  the  growth  of  the  ovum,  to  diminish  the  chances  of  rupt- 
ure and  hemorrhage.'  In  a  personal  interview  wath  Professor  Lusk 
he  stated  that  he  was  as  much  interested  in  the  electric  treatment 
as  ever,  but  lately  had  met  cases  in  which  hemorrhage  had  already 
occurred  and  which  required  operative  interference.  He  was  per- 
fectly convinced  of  the  efficacy  of  electric  treatment  in  suitable  cases, 
and  w^as  perfectly  sure  that  in  the  cases  in  which  he  had  successfully 
resorted  to  it  there  was  no  possibility  of  a  mistake  in  diagnosis. 

"Prof.  T.  G.  Thomas,  early  in  the  summer  (of  1893),  also  stated 
that  he  was  as  firm  a  believer  in  the  treatment  of  these  cases  by 
electricity  as  ever.  In  Thomas  and  Munde  on  'Diseases  of  Women' 
(Philadelphia,  1891)  it  is  stated:  'At  one  extreme  stand  able  and 
conservative  practitioners,  who  appear  to  favor  the  position  that,  as 
a  very  general  rule,  w^e  should  stand  calmly  by  with  folded  arms  and 
accept  without  effort  or  resistance  the  terrible  chances  of  death  which 
attend  these  cases.  At  the  other  we  see  enthusiastic  ones,  with  strong 
surgical  proclivities,  who  w^ould  apparently  resort  to  laparotomy  in 


*  "A  Treatise  on  the  Science  and  Practice  of  Midwiferv."  London.   1889. 


224 


DISEASES    OF    WOMEN. 


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226  DISEASES    OF  "WOMEN. 

every  case  in  which  diagnosis  is  possible.  On  a  middle  ground,  one 
lying  between  these  extremes,  the  truly  conservative  surgeon  will  find 
his  appropriate  position.' 

'•'Although  Pozzi  in  his  'Treatise  on  Gynecology'  (American 
edition,  1892)  condemns  the  use  of  electricity,  the  able  editor  of  this 
work  (B.  H.  Wells),  quoting  Byford,  says:  'If  we  have  a  case  of  extra- 
uterine pregnancy  in  the  early  months  it  is  safe  to  destroy  the  fetus 
by  electricity  and  keep  the  patient  in  bed  until  absorption  has  no- 
ticeably commenced.  If  profuse,  repeated  hemorrhages  occur,  it  is 
safer  to  operate  at  once.' 

"Parvin^  says:  'Throwing  aside  all  doubtful  cases,  there  remains 
a  strong  argument  from  actual  experience  in  favor  of  the  treatment 
of  ectopic  gestation,  prior  to  the  rupture  of  the  fetal  cyst,  by  elec- 
tricity.' 

"The  works  on  electricity  in  its  relation  to  gynecology  by  A. 
H.  Goelet,-  and  Grandin  and  Gunning,^  are  likewise  strongly  in  favor 
of  the  employment  of  electricity  in  the  treatment  of  early  cases  of 
ectopic  gestation.  Byford,  Mann,  Skene,  Wilson,  and  many  other 
eminent  specialists  in  gynecology  have  also  in  recent  times  expressed 
themselves  in  favor  of  this  plan  of  treatment. 

"The  Boston  Medical  Society,  at  its  meeting  held  on  November 
12th,  1892,  received  the  report  of  the  chairman  of  a  committee  ap- 
pointed to  investigate  the  present  condition  of  medical  opinion  with 
regard  to  the  subject  of  extra-uterine  pregnancy.*  The  report  reads: 
'Immediate  celiotomy,  so  soon  as  the  diagnosis  is  established,  is  then, 
in  the  judgment  of  your  committee,  the  only  treatment  which  should 
be  considered  before  rupture  of  the  tube.'  If  the  gentlemen  of  this 
committee  can  spare  the  time  to  review  the  facts  gathered  in  this 
paper,  they  may  charitably  allow  a  small  place,  at  least,  for  the  treat- 
ment of  some  of  these  cases  by  electricity.  The  fact  is,  in  spite  of 
the  highly  moral  position  taken  by  Lawson  Tait,  that  feticide  in 
extra-uterine  pregnancy  is  considered  justifiable  in  the  interests  of 
the  mother  by  a  great  many  practitioners.  It  is  also  a  fact,  which 
this  paper  proves,  that,  beyond  one  death  in  seventy-eight  cases,  no 


'"Science  and  Art  of  Obstetrics,"  Philadelphia,  1890. 
*"The  Electro-therapeutics  of  Gynecology,"  Detroit,  1892. 
*  "Practical  Treatise  on  Electricity  in  Gynecology,"  New  York,  1891. 
*E.  Reynolds,  Boston  Medical  and  Surgical  Journal,  January,  1893,  vol- 
ume cxxviii,  page  107. 


ECTOPIC    GESTATION    AND    OBSTETRICS.  227 

injury  has  ever  been  done  by  the  use  of  electricity,  and  where  it 
has  been  directly  abandoned  for  laparotomy  no  harm  was  done  by 
the  previous  treatment.  The  treatment  has  maintained  its  reputa- 
tion for  harmlessness;  and  although,  in  the  eyes  of  some,  it  has  been 
dubbed  'ridiculous'  and  'cowardly'  and  the  product  of  'ignorant  ob- 
stinacy/ it  continues  to  assert  itself  as  a  simple,  innocent  procedure 
which  has  its  own  proper  sphere  of  usefulness." 

Dr.  Brothers's  list  is,  in  itself,  sufficient  to  establish  both  the 
possibility  of  electric  feticide  and  the  advisability  of  its  employment 
in  the  class  of  cases  recommended  in  this  chapter;  but,  when  con- 
sidering it  as  a  record  of  the  cases  of  this  nature,  we  should  remem- 
ber that  many  other  patients  have  been  cured  under  vaginal  galvanic 
applications  which  were  possibly  instances  of  extra-uterine  pregnancy, 
but  where  diagnosis  was  too  uncertain  to  permit  them  to  be  consci- 
entiously reported  as  instances  of  this  affection. 

Abortion. — From  Avhat  has  been  said  in  the  preceding  paragraphs 
it  is  evident  that  in  electricity  we  have  a  feticide  of  positive  and 
definite  value  which,  when  applied  within  the  uterus,  is  certain  to 
arrest  the  life  of  the  embryo  in  those  cases  where  a  consultation 
determines  the  necessity  for  so  terminating  the  pregnancy.  The 
negative  pole  of  the  galvanic  current  is  preferable,  as  it  attracts 
moisture  by  cataphoresis  and  excites  flow,  the  current-strength  being 
from  30  to  75  milliamperes,  applied  on  a  carefully  asepticized  sound- 
shaped  electrode  insulated  beyond  the  internal  os.  Five  minutes  is 
a  sufficient  duration  every  other  day  for  a  week,  when  it  will  be 
found  that  the  ovum  is  so  reduced  in  size  and  detached  as  to  readily 
pass  away  with  but  moderate  uterine  contraction.  The  first  applica- 
tions are  best  made  with  the  elastic  instrument  (Fig.  33),  even  cotton- 
covered,  as  by  this  instrument  the  chances  of  puncturing  the  ovum 
are  diminished  and  the  likelihood  of  its  expulsion  entirely  increased. 
A  few  faradic  applications  subsequently  will  hasten  involution. 

Hyperemesis  Gravidarum. — Among  the  many  useful  remedies  for 
the  excessive  nausea  and  vomiting  of  pregnancy  none  is  more  certain 
than  the  application  of  a  fine-wire  faradic  current  to  the  solar  plexus 
at  the  epigastric  region.  The  anode  should  be  placed  at  the  back  of 
the  neck  and  the  cathode,  or  negative  pole,  at  the  pit  of  the  stomach, 
carefully  avoiding  the  uterine  region.  The  special  value  of  this  pro- 
cedure, which  is  confined  to  fine-wire  currents,  is  the  direct  sedation 
produced  by  it,  though  certain  cases  require  instead  that  the  sympa- 


228 


DISEASES    OF    WOMEN. 


thetic  nerves  in  this  situation  sliould  be  stimulated  by  galvanic  cur- 
rents of  15  to  30  milliamperes  applied  from  pads  placed  in  the  same 
position.  Either  of  these  procedures  is  likely  to  succeed  in  cases 
where  everything  else  fails,  rendering  the  induction  of  artificial 
abortion  unnecessary. 

Use  of  the  Faradic  Current  in  Labor. — This  is  a  subject  of  vast 
importance  to  the  practicing  obstetrician,  for  by  this  much-neglected 
means  a  too-slow  labor  may  be  hastened,  atony  of  the  uterus  cor- 
rected, post-partum  hemorrhage  instantly  controlled,  and  involution 
so  hastened  by  a  few,  or  at  times  only  one,  applications,  as  to  mate- 
rially lessen  the  lying-in  period. 

Suggestions  of  this  nature  were  made  a  number  of  years  ago 


Fig.  64. — Gaifle's  pocket  faradic  battery.  Tlie  exciting  fluid  is  made 
in  a  few  moments  from  bisulphate  of  mercury  carried  in  a  bottle  (K)  in 
a  dry  state,  a  spoonful  of  which  is  to  be  added  to  each  of  the  cells  (L) , 
water  added,  and  the  zincs  replaced. 


by  Tripier,  and  more  recently  by  Dr.  W.  T.  Baird,  of  Texas,  and 
Dr.  E.  J.  Nunn,  of  Savannah,  Ga.;  yet,  doubtless  owing  to  the  fact 
that  the  busy  accovchevr  has  no  battery  with  him  in  the  lying-in 
chamber  and  if  he  sends  to  his  office  for  it  finds  it  out  of  order, 
but  little  use  seems  to  have  been  made  of  these  suggestions.  Bearing 
in  mind  that  it  is  the  faradic  current  only  that  is  of  service  at  this 
time,  the  remedy  for  this  practical  difficulty  is  the  addition  to  the 
regular  contents  of  the  obstetric  bag  of  a  small  Gaiffe  battery  (Fig. 
64),  which  is  inexpensive  and  always  ready  for  use,  for  the  solution 
employed   is  made  instantly  by  the  addition  of  a  little  water  to  a 


ECTOPIC    GESTATION    AND    OBSTETEICS.  229 

spoonful  of  the  bisiilphate  of  mercury  carried  in  tlie  battery-case.  A 
more  powerful  coil  is,  at  times,  of  greater  service,  but,  as  the  prin- 
cipal obstetric  uses  of  the  faradic  current  are  due  to  its  contractile 
power,  the  primary  coil  of  the  Gaiffe  battery  should  be  employed  and 
the  resistance  of  the  circuit  diminished  by  having  the  external  pole 
or  poles  increased  in  size  by  a  folded  towel  well  wetted  with  a  solu- 
tion of  table  salt.  It  should  not  be  overlooked,  also,  that  in  all 
houses  that  are  lighted  by  the  Westinghouse  alternating  system  (page 
352),  we  have  an  excellent  faradic  current  at  hand  by  simply  un- 
screwing a  lamp  and  placing  a  Massey  or  Jewell  controller  in  circuit 
with  the  patient,  when  a  current  of  any  strength  is  obtainable  by 
turning  the  crank  to  a  point  that  gives  perceptible  results. 

Inertia  Uteri. — The  contracting  power  of  the  faradic  current  is 
not  entirely  barred  by  the  presence  of  the  child  in  the  uterus,  for, 
if  the  usual  head  presentation  exists  and  inertia  of  the  uterus  occurs 
in  spite  of  a  well-dilated  cervix,  we  may  apply  the  electrodes  (either 
ordinary  disk-electrodes  or,  preferably,  pads  about  the  size  of  the 
palm  of  the  hand)  on  either  side  of  the  fundus  near  the  navel,  and 
turn  the  current  on  forcibly  at  the  inception  of  each  pain,  or  about 
the  time  the  pain  should  appear,  turning  it  off  at  each  intermission 
and  repeating  the  procedure  regularly  for  a  time.  This  will  not  en- 
danger the  heart  or  respiration  of  the  child,  being  too  far  from 
these  vital  organs,  and  will  usually  soon  produce  such  vigorous  con- 
tractions that  the  forceps  may  be  left  untouched  while  time  is  saved 
to  the  physician  and  much  suffering  saved  to  the  patient.  My  own 
limited  experience  agrees  with  the  statement  of  Dr.  Baird,  that  the 
turning  on  of  the  current  synchronously  with  the  pains  very  mate- 
rially lessens  the  suffering  of  the  patient,  even  in  normal  labor,  while 
at  the  same  time  the  expulsive  forces  are  re-enforced. 

Post-partum  Hemorrhage. — T\lien  this  alarming  accident  is  due 
to  inertia  of  the  uterus,  which  fails  to  contract  properly  and  promptly 
after  delivery  of  the  placenta,  there  is  nothing  equal  in  immediate  and 
thorough  results  to  the  primary  or  coarse-wire  faradic  current  applied 
with  a  bipolar  electrode  within  the  uterus  or  a  single  active  pole  in 
that  situation  and  the  other  on  the  abdomen.  The  bipolar  electrode 
(page  66)  should  be  of  the  kind  capable  of  thorough  asepsis,  pref- 
erably in  the  flame  of  the  alcohol-lamp,  and  the  monopolar  electrode 
should  be  blunt  and  properly  insulated  and  asepticized.  In  an  emer- 
2:encv  where  such  instruments  are  inaccessible  an  intra-uterine  elec- 


230  DISEASES    OF    WOMEN. 

trode  may  be  improvised  for  so  large  a  cavity  from  a  piece  of  wire 
about  a  yard  long  and  a  piece  of  rubber  tubing  a  foot  or  eighteen 
inches  long,  in  the  following  manner: — 

Bare  a  considerable  portion  of  the  wire,  if  covered,  and  bend 
this  end  in  a  long  loop;  twist  and  fold  the  end  of  the  loop  into  a 
ball  that  will  project  beyond  the  end  of  the  rubber  tube  when  it  is 
passed  through  it,  one  end  of  the  wire  remaining  within  the  tube 
and  the  other  end  being  brought  out  at  the  opposite  end  of  the  tube 
and  twisted  around  the  tip  of  a  conducting-cord,  to  make  connection. 
The  whole  should  now  be  immersed  in  boiling  water  for  a  few  mo- 
ments to  insure  cleanliness,  after  which  the  knobbed  end  may  be 
inserted  into  the  cavity  and  the  instrument  connected  with  one  cord 
of  the  battery.  The  other  electrode  is  placed  on  the  abdomen  and, 
if  only  an  ordinary  disk-electrode,  may  be  increased  in  size  by  putting 
a  folded  napkin  beneath  it,  well  wetted  with  salt  water.  The  faradic 
current  only  is  to  be  applied  in  this  way. 

Recent  Subinvolution. — This  subject  has  been  treated  of  else- 
where (page  98),  but  it  should  be  said,  in  this  place,  that  subin- 
volution of  the  first  or  second  month  should  be  treated  by  the  faradic 
or  alternating  current,  preferably  bipolar,  though  monopolar  intra- 
uterine applications  of  either  of  these  currents  will  check  hemor- 
rhage, hasten  involution,  and  not  only  permit  a  prompt  getting-up, 
but  avert  later  consequences  in  the  shape  of  invitations  to  catarrhal 
invasions  that  so  often  supervene  on  this  condition. 


CHAPTER  XVIII. 
Malignant  Geowths. 

Amidst  the  many  uncertainties  as  to  the  true  nature  of  the 
various  forms  of  cancerous  disease  there  are  several  facts  that  all 
authorities  are  agreed  upon,  chief  of  which  are  the  strictly-localized 
character  of  the  affections  in  their  primary  stages,  and  that  the  seat 
of  malignancy  must  reside  in  the  special  forms  of  cells  found  in  the 
several  growths.  A  most  important  question  yet  undecided  is  the 
true  relation  of  these  cancer-cells  to  their  environment.  That  this 
relation  is  that  of  an  inoculable  germ  to  a  culture-medium  would 
seem  to  be  indicated  by  the  facility  with  which  autoinoculation  may 
occur,  either  by  grafts  conveyed  by  the  lymphatic  or  venous  circula- 
tions or  distributed  to  surrounding  absorbent  surfaces  by  the  knife 
used  to  cut  the  tumor.  Yet  the  persistent  efforts  of  several  observers 
have  been  but  indifferently  successful  in  the  grafting  of  cancer  from 
animal  to  animal.  It  is  evident  that  the  conditions  of  propagation 
are  of  a  far  more  delicate  nature  than  those  attending  the  ordinary 
microbic  affections,  and  that  the  discovery  of  these  conditions  will 
be  associated  with  a  greater  advance  in  our  knowledge  of  the  nature 
of  cancer  than  has  occurred  in  modern  times. 

The  important  question  of  the  prevention  of  cancerous  affec- 
tions, which  are  said  to  have  doubled  in  frequency  in  the  past  forty 
years,  must  await  this  definite  knowledge  of  their  causation.  Not 
so  their  treatment,  for  the  twin  facts  of  a  primarily-local  situation 
and  delimitation  of  malignancy  to  the  structure  itself  indicate  that 
early  and  thorough  removal  or  destruction  of  the  malignant  cells  is 
the  proper  course. 

While  this  early  destruction  of  a  local  malignant  growth  is  uni- 
versally recognized  as  the  only  hope  for  its  successful  eradication, 
its  accomplishment  by  the  ordinary  means  now  employed,  the  knife 
and  caustics,  is  rendered  difficult  by  the  absence  of  a  limiting  mem- 
brane or  capsule,  there  being  no  distinct  line  of  demarkation  between 
the  morbid  growth  and  surrounding  tissues,  the  growth  tending  to 

(231) 


233  DISEASES    OF    AVOMEN. 

invade  the  latter  in  every  direction  by  irregular  prolongations,  which 
are  often  extremely  difficult  to  trace  and  remove  at  the  operation. 
A  means  or  agenc}^  which  would  not  only  destroy  all  easily-accessible 
cancer-cells,  but  also  traverse  selectively  these  prolongations  with  the 
same  result,  is  necessarily  a  most  important  step  in  the  curative  thera- 
peutics of  this  affection.  Such  a  means  the  writer  presented  to  the 
profession  at  the  meeting  of  the  American  Medical  Association  at 
Philadelphia  in  1897,  in  the  massive  dissemination  of  the  nascent 
oxychlorides  of  mercury  and  zinc  throughout  the  tumor  and  its  rami- 
fications.^ 

The  special  merit  of  this  method  is  that  not  only  are  the  malig- 
nant cell-structures  destroyed  in  all  portions  of  the  growth  where  they 
are  evident  to  the  senses,  but  the  hidden  ramifications  are  also  sought 
out  by  a  diffusing  current  carrying  nascent  chemicals  of  a  lethal 
character,  which  traverse  the  cancer-ramifications  as  paths  of  least 
resistance,  thus  substituting  a  physical  law  for  the  unaided  senses  of 
the  operator  as  a  detecter  and  destroyer  of  the  more  distant  ramifica- 
tions. In  addition,  it  is  the  purpose  of  this  method  to  arouse  the 
defeated  physiologic  resistance  of  the  surrounding  tissues  into  re- 
newed activity,  that  the  errant  cellular  action  may  be  again  brought 
under  the  control  of  the  trophic  nervous  system. 

The  treatment  of  cancer  by  electricity  alone  is  by  no  means  a 
new  thing,  instances  of  successful  results  having  been  published  by 
many  physicians  during  the  last  forty  years,  and  an  important  paper 
contributed  to  the  subject  by  Dr.  Eobert  Newman,  of  New  York, 
at  the  meeting  of  the  American  Electro-Therapeutic  Association  in 
1891.  That  these  reported  results  attracted  but  little  attention  was 
doubtless  due  to  the  fact  that  they  all,  with  the  exception  of  those 
of  Dr.  Newman,  occurred  in  the  dark  ages  of  electricity,  when  it  was 
practically  impossible  to  duplicate  the  conditions  under  which  the 
agent  was  used,  it  being  impossible  to  measure  it,  and  doubtless 
often  impossible  to  generate  it  in  sufficient  dose  except  by  accident.'* 


'  See  Medical  Record,  July  31,  1897. 

*  For  an  excellent  bibliographic  review  of  the  treatment  of  cancer  by 
electricity  in  the  past  see  an  article  by  Mrs.  Edith  Faithfull  in  the  Contem- 
porary Magazine  (English)  for  March,  1892,  the  AAriter  stating  that,  having 
been  placed  under  this  treatment  after  failure  of  the  knife,  she  had  searched 
out  the  literature  of  the  subject.  She  has  gathered  a  remarkable  number  of 
references  to  its  successful  use. 


MALIGNANT    GROWTHS.  _  233 

It  is  to  Inglis-Parsons,  of  London,  that  we  owe  the  revival  of  interest 
in  this  subject  since  the  opening  of  the  present  age  of  electric  power 
under  control.^  Eejecting  simple  electrolysis  as  a  chief  mode  of 
action,  he  prefers  sudden  current-alternatives  of  high  power  (400 
milliamperes),  applied  by  means  of  needles  which  include  both  poles 
within  the  tumor,  the  '^'traumatic  action  produced  by  the  sudden 
impact  of  a  powerful  alternating  current  through  the  tissues  between 
the  two  points  of  insertion"  being  chiefly  relied  upon. 

As  this  method  is  extremely  painful  by  reason  of  the  shocks 
given  as  well  as  the  bulk  of  current,  the  patient  is  fully  anesthe- 
tized. The  following  extract  gives  a  full  description  of  his  method 
of  treating  malignant  growths  as  adapted  to  the  special  variety  men- 
tioned:— 

Inglis-Parsons's  Method  in  Epithelioma  of  the  Portio  Vagi- 
nalis.-— "These  eases,  taken  at  an  early  stage,  are  very  promising, 
because  the  disease,  as  a  rule,  has  neither  extended  deeply  nor  in- 
vaded the  lymphatic  glands.  If  an  operation  is  decided  on,  the  pa- 
tient should  be  kept  in  bed  for  a  few  days,  and  an  antiseptic  douche 
should  be  used  until  the  vagina  is  aseptic.  The  patient  is  then  placed 
on  the  operating-table,  in  the  lithotomy  position;  ether  is  adminis- 
tered. The  next  step  to  be  taken  will  depend  on  the  size,  extent, 
and  characters  of  the  growth.  If,  for  instance,  there  is  a  large  ulcer 
with  a  great  deal  of  soft,  breaking-down  tissue,  it  is  better,  as  a 
preliminary  measure,  to  scrape  this  with  a  blunt  curette,  and  apply 
strong  perchloride  of  iron  to  check  bleeding.  In  applying  the  curette 
no  force  should  be  used;  only  the  friable  material  which  comes  away 
easily  should  be  removed.  One  advantage  of  doing  this  is  that  the 
parts  can  be  made  thoroughly  antiseptic:  a  consideration  not  to  be 
lost  sight  of  when  we  may  require  to  puncture  the  cellular  tissue 
around  the  uterus  through  the  vaginal  w^all. 

"In  other  cases,  where  the  ulceration  is  slight  and  the  tissues 
superficial,  the  curette  is  not  required.  Now,  in  the  treatment  of  epi- 
thelioma by  electricity  it  is  necessary  to  rely  upon  the  caustic  action 
of  the  two  poles,  for  the  reason  stated  before,  that  this  form  of 


'  "The  Healing  of  Rodent  Cancer  by  Electricity,"  by  J.  Inglis-Parsons. 
London,  1893:    John  Bale  &  Sons. 

-  The  author's  method  as  applied  to  this  affection  will  be  found  on  page 
253. 


234  _  DISEASES    OF    WOMEN. 

growth  has  a  higher  electrical  resistance  than  the  healthy  tissues.^ 
Sims's  speculum  is  passed  into  the  vagina;  the  cervix  is  taken  hold 
of  by  a  strong  pair  of  tenaculum  forceps  and  pulled  down  as  far  as 
possible  to  the  vaginal  outlet  by  an  assistant.  A  second  assistant 
stands  at  the  batteries,  watches  the  galvanometer,  increases  the  num- 
ber of  the  cells  in  the  circuit,  and  alternates  the  current  by  means 
of  a  commutator,  according  to  the  directions  of  the  operator.  Two 
needles  at  a  time  only  are  used.  One  of  these  should  be  run  into 
the  growth;  the  other,  held  in  the  operator's  hand  and  having  a  sharp 
point,  makes  a  trench  into  the  healthy  tissue  all  around  the  growth. 
The  depth  of  this  will  depend  on  the  case.  Through  this  edge  the 
needle  should  be  pushed  under  the  growth;  a  current  of  400  milliam- 
peres  is  left  on  for  ten  seconds,  and  then  alternated  by  the  assistant 
with  the  commutator  for  another  ten  seconds.  The  position  of  the 
needle  should  then  be  changed.  In  this  manner  the  whole  of  the 
growth  must  be  undermined,  and  when  the  operation  is  finished  the 
whole  of  it  should  look  bloodless  and  almost  black.  When  the  growth 
is  extensive  it  may  be  necessary  to  do  two  operations.  As  a  rule,  I 
never  go  on  for  more  than  an  hour  at  a  time.  For  carcinoma  of  the 
cervix  the  same  precautions  must  be  observed  to  keep  the  patient 
aseptic.  As  the  ulceration  is  generally  more  extensive  in  these  cases, 
the  use  of  the  curette,  for  scraping  away  all  of  the  dead  tissues 
available,  becomes  more  necessary.  It  must  be  done  thoroughly,  and, 
if  there  is  a  cauliflower  excrescence,  this  must  be  removed.  Hemor- 
rhage can  usually  be  checked  by  applying  a  pledget  of  cotton-wool 


'  The  electric  resistance  of  cancer-tissue  depends  greatly  upon  its  Iiis- 
tologic  arrangement.  The  greater  the  proportion  of  cells,  the  less  the  resistance, 
particularly  if  the  cells  be  cylindric  rather  than  the  squamous  variety;  and, 
the  greater  the  proportion  of  connective  tissue,  the  less  the  resistance.  In 
cauliflower  excrescence  and  soft  medullary  tumors  the  cells  are  in  excess  and 
the  resistance  less  than  in  normal  tissue.  In  the  squamous-celled  variety,  so- 
called  "scirrhus,"  the  resistance  is  likely  to  be  much  greater  than  normal,  as 
stated  by  Dr.  Parsons.  It  should  be  remembered,  however,  that  even  in  scirrhus 
the  resistance  is  greatest  in  the  centre  of  the  growth  and  least  at  the  periph- 
ery, where  we  wish  the  electricity  to  be  the  most  deadly.  In  any  case  the 
cellular  parenchyma  of  a  cancer  will  convey  more  current  than  the  fibrous 
stroma,  since  it  contains  more  water;  hence  a  moderate  current  traversing  a 
scirrhous  formation  may  be  lethal  to  the  scanty  parenchyma  by  reason  of  con- 
centration.— G.  B.  M. 


MALIGNANT    GROWTHS.  235 

soaked  in  the  strong  solution  of  perchloride  of  iron.  Bleeding  vessels 
must  be  secured  in  the  usual  way. 

"When  the  patient  is  in  a  fit  condition  and  the  vagina  is  clean  and 
free  from  odor,  a  second  operation  may  be  done  with  electricity.  The 
patient  is  placed  in  the  lithotomy  position  and  the  batteries  and  assist- 
ants arranged  as  before.  It  is  advisable  for  the  anesthetist  to  keep  his 
finger  on  the  pulse  and  indicate  to  the  operator  any  serious  variation. 
A  blunt  electrode  is  now  passed  np  to  the  fundus  and  a  needle  is 
passed  throngh  the  vaginal  wall  into  the  cellular  tissue  surrounding 
the  uterus.  The  current  is  then  flashed  through  and  alternated.  It 
should  be  allowed  to  pass  for  three  seconds  at  a  time.  After  ten 
interruptions  the  position  of  the  electrodes  can  be  changed.  The 
blunt  electrode  should,  during  half  of  the  operation,  be  brought  into 
contact  with  the  ulcerated  surface  which  has  already  been  curetted. 
A  second  blunt  electrode  may  be  passed  into  the  bladder^  and  the 
current  sent  through  from  uterus  to  bladder,  and  also  to  the  rectum. 
The  number  of  punctures  required  and  the  duration  of  the  operation 
will  depend  entirely  upon  the  extent  of  the  disease,  and  must  be 
left  to  the  judgment  of  the  operator.  It  is  advisable  to  repeat  the 
operation  at  the  end  of  ten  days  or  a  fortnight.  The  patient  can 
then  be  seen  occasionally."^ 

While  the  method  thus  described  by  Dr.  Parsons  presents  dis- 
tinct advantages  over  the  knife  in  certain  cases,  as  claimed  by  him 
(and  it  should  be  stated  that  he  does  not  claim  that  it  is  best  in 
every  case),  it  is  to  be  observed  that  it  fills  but  one  of  the  require- 
ments laid  down  at  the  beginning  of  this  chapter,  viz.:  destruction 
of  all  apparent  portions  of  the  growth.  The  knife  also  does  this  prob- 
ably as  fully  as  this  method.  The  method  does  not  subject  the 
apparently  healthy  tissues  beyond  the  growth  to  an  influence  capable 
of  destroying  latent  centres  of  regrowth,  as  may  be  done  by  a  monop- 
olar application  and  radial  diffusion.  Its  principal  advantage  over 
the  knife  is  bloodlessness. 

It  is  a  question,  also,  whether  the  mode  by  which  it  acts  is  not, 
after  all,  the  electrolytic  action  of  so  large  a  current,  even  if  the 


^  The  author  would  hesitate  to  employ  a  current  of  this  strength  in  these 
cavities  unless  they  were  themselves  invaded  by  the  growth.  ' 

^  "International  System  of  Electro-Therapeutics,"  page  G-233.  Philadel- 
phia:   The  F.  A.  Davis  Co. 


236  DISEASES    OF    WOMEN. 

duration  be  slight  and  the  polarity  subsequently  reversed.  The  de- 
scription of  the  condition  of  the  growth  after  the  operation  is  quite 
identical  with  the  appearance  of  a  similar  growth  after  electrolytic 
destruction  with  the  direct  current.  In  ten  seconds  considerable 
electrolysis  can  be  accomplished  with  400  milliamperes,  and  if  the 
electrolysis  is  then  reversed  the  position  of  the  ions  will  change  place, 
but  the  electrolytically-killed  tissue  will,  of  course,  not  be  revived. 
In  an  hour's  work  with  a  current  of  this  strength  so  frequently  re- 
versed in  a  small  space  the  included  tissues  are  largely  reduced  to 
simple,  chemic  elements.  It  is,  however,  possible  that  the  shock  of 
sudden  reversals  of  a  ten-second  current  may  have  a  lethal  action  of 
its  own  on  cell-life. 

Author's  Method  of  Mercuric  Cataphoresis  as  a  Cure  for  Cancer. 
— It  was  with  the  encouraging  precedents  of  Dr.  Inglis-Parsons's  un- 
doubted successes  that  the  author  began  experimenting  with  carci- 
noma of  the  cervix  uteri  a  number  of  years  ago,  and  later  with  sarcoma 
of  other  portions  of  the  body,  and  after  several  preliminary  publica- 
tions^ he  is  now  in  a  position  to  report  results  which,  though  few  in 
number  and  not  always  successful,  yet  point  to  the  germ  of  a  truth 
of  vast  importance  to  the  human  race;  for  the  history  of  the  cases 
will  show  that  the  active  principle  of  sarcoma  and  carcinoma  can  be 
killed  by  cataphorically  impregnating  the  tumor  with  nascent  oxy- 
chloride  of  mercury  in  sufficiently  massive  dose,  while  the  cancer- 
holding  tissues  are  not  killed. 

The  destructive  effects  of  caustics  on  these  growths  is  well  known, 


*  ''Local  Electrolysis  and  Zinc- Amalgam  Cataphoresis  in  Malignant  and 
Non-malignant  Tumors,"  Medical  News,  March  9,  1895. 

"The  Treatment  of  Hemorrhagic  Conditions  of  the  Uterus  by  Zinc- Amal- 
gam Cataphoresis,"  Journal  of  the  American  Jledical  Association,  August  24, 
1895. 

"Zinc- Amalgam  Cataphoresis  in  Mucopurulent  Inflammations  and  Malig- 
nant Growths,"  Philadelphia  Polyclinic,  October  19,  1895. 

"On  a  New  Treatment  of  Sarcoma,"  American  Medico-Surgical  Bulletin, 
June  27,  1896. 

"The  Treatment  of  Cancer  by  a  New  jNIethod,  viz.:  the  Electrical  Dif- 
fusion of  Nascent  O.xychlorides  of  Mercury  and  Zinc,"  ]\Iedical  Record,  July 
31,  1897. 

"On  the  Radical  Cure  of  Malignant  Disease  by  the  Cataphoric  Diffusion 
of  Mercury  from  Gold  Electrodes,  with  details  of  Lat€  Improvements  in  the 
Author's  Method,"  Philadelphia  Medical  Journal.  March  19,  1898. 


MALIGNANT    GKOWTHS.  237 

but  they  act  only  where  lAsiced,  exactly  as  the  knife  does.  By  the 
cataphoric  method  a  relatively-infinitesimal  portion  of  the  mercuric 
oxychloride  acts  lethally  on  the  cancer-cells  because  of  its  nascent 
condition,  and  because  it  is  carried  by  the  current  into  the  very  cells 
themselves.  But  the  most  important  point  is  that  by  the  method  we 
may  cause  the  medicinally-laden  current  to  seek  out  and  follow  the 
paths  of  proliferation  of  the  growth  by  reason  of  its  selection  of  paths 
of  least  resistance,  and  it  is  the  failure  to  destroy  these  incipient 
proliferations  that  causes  the  frequent  reappearances  after  attempts 
at  extirpation  with  the  knife.  This  selective  tendency  of  the  current 
is  both  absolute  and  relative,  in  the  one  sense  being  due  to  the  phys- 
ical fact  that  cancerous  ramifications  usually  invite  the  passage  of  a 
greater  current  in  its  transit  from  the  active  pole  placed  within  the 
growth  to  the  distant  indifferent  pole  by  reason  of  a  less  electric 
resistance,  due  to  its  cellular  structure;  and,  in  the  other  sense,  a 
selective  action  results  from  the  lessened  physiologic  resistance  of  the 
cancer-tissue  as  compared  with  surrounding  structures.  Some  of  my 
cases  have  clearly  proved  that  the  cancer-cell  has  less  physiologic  re- 
sistance to  this  interstitial  attack  than  normal  tissue,  for  it  is  found 
to  lose  its  vitality  at  some  distance  from  the  electrode  without  being 
accompanied  by  necrosis  of  the  healthy  tissue. 

This  diffusion  of  a  metal  from  a  corrodible  electrode  occurs  only 
at  the  positive  pole,  as  explained  elsewhere  (page  40);  it  is,  therefore, 
necessary  to  connect  the  active  electrode  to  this  pole  of  the  battery, 
and  to  furnish  as  large  and  perfect  an  indifferent  electrode  as  can  be 
placed  elsewhere  on  the  body.  It  was  the  oxychloride  yielded  from 
a  zinc  electrode  coated  with  mercury  which  first  attracted  the  author's 
attention  to  the  possibilities  of  the  cataphoric  injection  of  lethal 
products  into  cancer-tissue.  These  experiments,  which  began  in  1893, 
were,  however,  but  partially  successful,  owing  to  the  small  dosage 
employed,  and  it  has  only  been  since  May,  1897,  and  since  the  em- 
■  ployment  of  complete  anesthesia  and  massive  doses,  that  the  great 
value  of  the  application  has  been  demonstrated. 

Coincident  with  the  use  of  anesthesia  for  the  purpose  of  an 
immediate  penetration  of  all  portions  of  the  cancer  was  the  discovery 
that  mercury  could  be  employed  as  the  active  agent  by  amalgamating 
a  gold  electrode  with  it,  and  that  when  mercury  was  so  used  it  quickly 
disappeared  into  the  tissues:  a  phenomenon  not  before  observed.  All 
that  remained  to  be  done  after  this  discovery  was  to  devise  means  to 


238 


DISEASES    OF    WOMEN. 


keep  up  the  supply  of  mercury  at  the  active  surface  of  the  gold  in 
order  that  a  proper  amount  of  the  nascent  salt  might  be  disseminated 
through  the  tumor,  for  the  merely-amalgamated  surface  became 
quickly  bare  under  any  considerable  current.  This  was  accomplished 
by  having  the  instruments  (Fig.  66)  made  hollow  and  perforated 
at  the  active  extremities,  in  order  that  the  mercury  could  be  injected 
freely  about  the  active  surface  before  the  current  was  turned  on,  a 
small  glass  syringe  being  used  to  inject  the  metal  through  a  soft- 
rubber  tube. 


Fig.  65. — The  Massey  transfjortable  galvanic  battery,  as  made  by 
Williams,  Brown  &  Earle,  Philadelphia.  The  special  features  of  this  battery 
are  the  large  size  of  the  cells  and  their  ability  to  permanently  resist  acids, 
being  made  of  glass;  the  special  mechanism  for  instant  removal,  amal- 
gamation, and  replacement  of  the  elements;  and  the  mechanism  Avhich 
permits  of  lowering  and  raising  the  elements  with  ease  or  of  leaving  them 
in  any  position  desired.  At  A  A  are  the  binding-posts  for  attachment  of 
the  cords,  the  posts  having  their  polarity  marked  on  them.  These  posts 
rest  on  a  sliding  volt-  or  cell-  selector  (B),  which  permits  any  number  of 
cells  to  be  selected,  as  in  the  old-fashioned  batteries,  making  a  convenient 
controller  for  very  high   currents.     To  the  element  bar    (C)    the  element 


MALIGNANT    GEOWTHS.  239 

Details  of  the  Author's  Major  Method. — Source  of  Current. — 
The  street-mains  of  an  Edison  incandescent  lighting  current  of  110 
volts  may  be  used,  but  the  author's  work  has  been  done  with  two 
thirty-cell  batteries  of  the  acid-carbon  variety  coupled  in  series,  giv- 
ing a  combined  pressure  of  about  120  volts.  This  battery  force  is 
usually  essential,  as  the  available  current  required  varies  from  350 
to  1200  milliamperes  or  more.  The  batteries  must  be  in  the  best 
condition,  freshly  cleaned,  reamalgamated,  and  freshly  charged.  The 
ordinary  portable  galvanic  batteries  have  too  small  a  cell  to  main- 
tain this  current-strength  with  certainty,  and  I  have,  therefore,  de- 
signed a  transportable  battery  with  larger  cells  and  better  mechanism 
(Fig.  65)  two  of  which  can  be  relied  upon  to  give  sufficient  current 
during  the  time  required.  They  are  made  by  Williams,  Brown  & 
Earle,  of  Philadelphia.  The  two  batteries  are  placed  in  series  by  con- 
necting the  negative  pole  of  the  first  with  the  positive  of  the  second, 
when  the  positive  pole  of  the  first  and  the  negative  pole  of  the  second 
will  be  the  poles  of  the  combination.  Cords  from  these  are  carried 
to  the  binding-posts  of  the  switch-board. 

Electrodes. — Considerable  experimentation  was  required  in  de- 
vising the  golden  electrodes  to  be  used  in  this  electro-mercuric  treat- 
ment of  cancer.  The  earlier  applications  of  mercuric  cataphoresis 
were  made  with  zinc  electrodes  heavily  coated  with  mercury,  but  it 
was  soon  seen  that  the  zinc  surface  became  deeply  eroded,  and  that  a 
pure  mercuric  dissemination  would  require  a  more  refractory  surface 
for  the  electrode,  and  would  probably  produce  quite  different  efEects 
from  that  caused  by  the  mixed  chlorides.  The  only  metal  sufficiently 
resistant  to  the  current  that  would  combine  with  mercury  was  gold. 


connectors  {E)  are  attached  by  a  special  device,  which  permits  any  pair 
of  elements  to  be  instantly  removed  or  replaced.  The  elements  when  in 
position  are  simultaneously  raised  and  lowered  by  the  worm  {D  D), 
which  is  operated  by  beveled  cog-wheels  actuated  by  a  lever-handle.  A 
few  turns  of  the  handle  will  immerse  the  elements  to  any  extent  desired, 
in  which  position  they  will  remain,  thus  forming  an  additional  means  of 
controlling  the  output  of  the  battery.  This  form  of  battery,  transport- 
able rather  than  portable,  has  been  designed  to  furnish,  Avithout  detri- 
mental self-heating,  the  strong  currents  employed  in  the  treatment  of 
cancer,  but  is  equally  well  adapted  to  ordinary  medical  work,  the  increased 
weight  being  offset  by  greater  duration  of  the  charge  and  of  the  zinc 
element.  The  cells  should  be  emptied  before  being  sent  out,  and  refilled 
in  the  operating-room  with  electropoion  fluid. 


240  DISEASES    OF    WOMEN. 

although  it  was  soon  observed  that  this  metal  would  also  be  slightly 
eroded  by  a  powerful  current,  resulting  in  the  diffusion  of  a  mer- 
curic chloride  slightly  mixed  with  auric  chloride;  this  mixture,  un- 
like that  of  zinc  and  mercury,  was  not  essentially  cauterant,  and 
therefore  fulfilled  the  conditions  frequently  demanded  of  cell-de- 
struction without  necrosis  of  the  tumor. 

Eighteen-karat  gold,  in  which  the  alloy  should  be  silver,  give 
the  necessary  rigidit}',  the  alloy  in  the  surface  of  the  gold  soon  dis- 
appearing in  the  first  use  of  the  instrument.  The  shape  given  to 
the  electrodes  designed  to  pierce  tumors  is  shown  in  Fig  66,  and  the 
blunt,  or  bulbous,  electrode  for  use  in  cavities  in  Fig.  67.  After 
amalgamation  the  gold  becomes  brittle,  so  that  it  is  necessary  to 
construct  the  distal  end,  to  which  the  conducting  cord  is  attached, 
of  some  other  metal  not  affected  so  easily.  TJie  larger  electrode  (1, 
Fig.  66)  is  finished  with  platinum  for  this  reason  and  the  small  one 
with  silver.  (Platinum  is  totally  unaffected  by  mercury,  but  silver 
will  absorb  it,  though  more  slowly  than  gold.)  These  electrodes 
have  been  made  for  me  with  great  care  by  Baerncopf  &  Co.,  731 
Sansom  Street,  Philadelphia. 

Both  electrodes  are  so  constructed  as  to  be  capable  of  being 
heated  to  a  red  heat  in  the  flame  of  a  Bunsen  burner  or  alcohol-lamp 
after  use,  and  this  should  invariably  be  done,  when  all  the  mercury 
will  be  driven  off  in  a  green  vapor,  leaving  the  gold  clean  and  safe 
from  further  action  of  the  mercury,  as  well  as  safe  from  danger  of 
being  broken.  The  same  care  should  be  bestowed  on  the  gold  bulb 
and  the  metallic  portion  of  the  shank  of  the  bulbous  electrode.  While 
thus  getting  rid  of  the  remaining  mercury  that  would  otherwise  ren- 
der them  brittle,  this  heating  of  the  electrodes  results  in  complete 
asepsis  of  the  instruments  preparatory  to  their  future  use. 

When  preparing  for  an  application,  the  electrode  or  electrodes 
to  be  used  should  be  amalgamated  again,  ample  time  being  allowed 
to  do  this  thoroughly.  To  make  the  mercury  adhere  to  the  gold  a 
bit  of  absorbent  cotton  should  be  moistened  with  dilute  sulphuric 
acid  and  the  electrode  rubbed  on  it  and  dipped  in  mercury  alternately, 
until  an  abundance  of  the  fluid  metal  adheres  to  all  parts  of  the 
active  surface.  Should  it  be  desirable  to  insulate  the  shank  of  the 
electrodes,  this  may  be  done  for  each  application  by  fusing  shellac 
upon  it  to  the  extent  desired,  but  this  shellac  should  be  removed  in 
the  subsequent  heating  process,  in  order  that  all  portions  of  the  in- 


MALIGNANT    GROWTHS. 


241 


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242 


DISEASES    OF    WOMEN. 


strument  be  freed  from  the  mercury  before  being  put  away.  The 
steel  trocar  in  the  smaller  electrodes  should  be  removed  for  both 
heating  and  reamalgamation,  and  asepticized  in  some  other  way. 

The  Indifferent  Pad. — On  the  operating-table  a  lead  plate  is 
laid,  about  12  x  20  inches  in  size,  to  which  is  affixed  a  binding-post 
for  attachment  of  the  negative  cord.  Over  this  is  laid  a  thick  pad 
of  some  absorbent  material  well  soaked  with  hot  water.  This  pad 
should  be  thick  enough  to  prevent  local  action,  and  should  extend 
well  over  the  edges  of  the  lead  plate. 

Preliminary  Details. — Before  etherization  is  begun  the  batteries 
and  switch-board,  or,  in  the  absence  of  the  latter,  a  separate  con- 
troller and  meter,  should  be  properly  disposed  and  connected  and  the 


Fig.  67. — Hollow,  bulbous  electrode  of  gold,  for  dissemination  of 
mercury  in  cavities. 


perfection  of  circuit  tested.  Arranged  on  an  aseptic  tray  on  a  con- 
venient table  there  should  be  a  bistoury  for  making  incisions  for  the 
electrodes;  the  electrodes  themselves,  thoroughly  and  freshly  amal- 
gamated and  with  rubber  tubes  attached  for  injection  of  the  mer- 
cury; and  a  small  glass  syringe  filled  with  metallic  mercury.  An 
additional  supply  of  mercury  should  be  placed  in  a  dish  on  the  table. 

Assistants. — Besides  the  etherizer,  the  operator  will  need  an 
assistant  to  inject  the  mercury  after  the  electrodes  are  inserted  and 
another  assistant  to  turn  on  the  controller,  the  operator  himself  being 
sufficiently  employed  in  the  management  of  the  electrodes  and  in 
noting  the  current-strength  and  effects. 

The  Applicatio7i. — The  patient  having  been  etherized  and  placed 


MALIGNANT    GROWTHS. 


243 


on  the  table,  or  etherized  on  the  table  itself  (Fig.  68),  the  indifferent 
pad  should  be  examined  and  pressed  close  to  the  body,  the  greater 
portion  of  it  being  behind  the  hips  and  against  the  thighs.  No  por- 
tion of  the  metal  plate  shonld  toneh  the  body.  With  a  narrow  bis- 
toury a  slit  should  be  made  in  the  tumor  in  an  appropriate  spot  and 
an  electrode  thrust  deeply  into  place,  near,  but  not  too  close,  to  its 
base,  for  the  principal  action  is  downward.  In  hemorrhagic  tumors 
the  slight  hemorrhage  that  this  occasions  may  be  avoided  by  insert- 


Fig.  68. — Arrangement  of  apparatus  and  patient  in  the  cataphoric 
treatment  of  cancer. 


ing  the  electrodes  as  the  negative  pole  by  temporarily  reversing  the 
connections  and  turning  on  sufficient  current  for  this  purpose. 

Having  inserted  the  electrode  or  electrodes  required  and  veri- 
fied the  polarity  of  the  active  electrodes  as  surely  positive,  the  glass 
syringe  should  be  inserted  in  the  tubes  of  each  electrode  in  turn  and 
an  abundance  of  mercury  forced  into  them  and  into  the  tissues  about 
them.  The  necessity  for  an  excess  lies  in  the  rapid  dissipation  of  the 
portion  adhering  to  the  gold  under  a  strong  current,  and,  unless  an 


244  DISEASES    OF    WOMEN. 

abundance  of  the  metal  remains  in  electric  contact  previovisly  to  turn- 
ing the  current  on,  the  gold  will  lose  contact  with  the  mercury  near 
it,  and  a  mere  positive  cauterization  will  result.  The  mercury  is  held 
within  the  electrode  by  the  spring  clip.  Should  the  duration  of  the 
application  be  considerable,  additional  quantities  of  the  mercury  may 
be  injected  without  interference  with  the  current. 

The  Current-strength  and  Current-duration. — The  strength  of 
the  current  and  its  duration  depend  entirely  on  the  extent  of  the 
growth.  The  author's  applications  under  ether  have  thus  far  varied 
between  350  and  1200  milliamperes,  and  in  duration  between  four- 
teen minutes  and  half  an  hour.  It  is  quite  likely  that  both  of  these 
extremes  can  be  wisely  increased  in  large  growths  where  immediate 
results  are  necessary,  for  it  is  evident  that  a  sufficient  quantity  of 
mercury  should  be  acted  on  and  disseminated  to  produce  a  lethal 
density  of  the  agent  in  all  parts  of  the  growth,  no  group  of  cells  being 
permitted  to  escape.  That  this  will  require  a  time  proportional  to 
the  distance  of  the  remotest  groups  of  cells  from  the  nearest  electrode 
is  evident  from  the  statements  concerning  the  cataphoric  speed  of 
substances  on  page  46.  No  increase  of  current  will  male  up  for  a 
lacTc  of  'penetration  due  to  insufficient  duration. 

It  should  be  the  aim  of  the  operator  to  accomplish  complete 
results  at  the  first  application,  though  a  second  application  can  be 
made  a  month  later,  if  it  is  seen,  during  the  healing  process,  that  this 
aim  has  not  been  accomplished. 

Immediate  liesults. — Within  a  few  moments  after  an  adequate 
current  has  been  turned  on  the  tumor  will  become  somewhat  blanched 
and  shrunken,  these  appearances  increasing  during  the  application. 
About  each  electrode  a  grayish-white  necrotic  area  will  form,  of  lim- 
ited extent,  which  will  serve  to  maintain  subsequent  drainage.  If 
there  has  been  any  odor  due  to  previous  necrosis  or  ulceration  of  the 
cancer,  this  will  disa])pear  during  the  application,  and  will  not  be 
likely  to  return  if  the  application  has  been  thorough. 

The  amount  of  pain  suffered  by  tlie  patient  after  emerging  from 
the  ether  varies.  If  the  tumor  is  large  and  previously  painful,  the 
latter  will  be  lessened  permanently  by  the  application,  though  severe 
pain,  which  is  readily  controlled  by  morphine,  is  often  felt  for  several 
days  subsequently  when  the  cataphoric  action  has  been  carried  deeply 
into  healthy  tissue  and  the  secondary  reaction  has  been  well  estab- 
lished.    This  secondary  reaction  is  a  marked  feature  after  applica- 


MALIGNANT    GROWTHS.  245 

tions  to  organs  that  are  only  partially  infected  by  the  cancer.  It  is 
doubtless  due  to  an  irritative  reaction  of  the  surrounding  normal 
tissue,  and  thus  assists  in  delimiting  further  cancerous  growth  at  the 
periphery  of  the  tumor.  The  reaction  and  accompanying  pain  cease 
about  the  third  day^,  when  the  patient  is  free  from  pain  and  will  re- 
main so. 

After-treatment. — The  tumor  is  dressed  with  dry  acetanilid  pow- 
der and  absorbent  cotton  daily,  after  being  cleansed  from  the  gray 
discharges  and  the  excess  of  mercury  which  pour  out,  and  the  wounds 
become  clean  and  ready  to  heal  by  granulation  in  from  twelve  days 
to  three  weeks.  During  this  process  there  is  but  little  tenderness 
and  no  unpleasant  odor. 

Details  of  the  Author's  Minor  Method. — Most  of  the  earlier  cases 
mentioned  below  were  treated  by  the  milder  method,  in  which  anes- 
thesia was  not  used  and  amalgamated-zinc  electrodes  were  employed. 
The  action  of  the  combined  zinc-mercuric  oxychlorides  formed  from 
such  electrodes  is  totally  different  from  that  of  pure  mercuric  cata- 
phoresis,  a  whitish  eschar  being  quickly  formed  about  each  electrode, 
which  becomes  an  extensive  slough  if  a  strong  current  is  used.  This 
slough  is  'not  entirely  inodorous,  but  has  a  special  value  when  quick 
destruction  of  an  hemorrhagic  sarcoma  of  large  size  is  desired,  when 
the  zinc  may  be  used  in  the  major  method  without  causing  the  loss 
of  a  drop  of  blood.  The  currents  usually  tolerated  without  ether 
rarely  exceed  50  to  80  milliamperes,  according  to  the  location  of  the 
growth,  though  I  have  used  300,  the  details  of  the  application  being 
otherwise  the  same  as  in  the  major  method.  It  should  be  repeated 
daily  or  as  often  as  possible  until  a  cure  is  effected. 

The  minor  method,  with  either  zinc  or  gold  electrodes,  is  suit- 
able for  small  local  growths  and  in  cavities  in  which  the  assistance 
of  direct  vision  is  lacking,  but  it  is  always  inferior  to  a  thorough 
application,  and  should  never  be  employed  without  a  reasonable  pros- 
pect of  a  speedy  mastering  of  the  growth. 

Such  is  a  brief  outline  of  the  methods  and  their  technical  details, 
but  it  should  be  understood  that  these  details  are  subject  to  change, 
in  accordance  with  the  individual  characters  of  the  growth  and  the 
part  of  the  body  in  which  it  is  situated.  The  underlying  principle 
that  constitutes  the  novelty  of  the  method  is  that  there  is  a  virtue 
in  the  electric  diffusion  of  nascent  chemicals  throughout  a  malignant 
growth  which,  when  of  sufficient  density  per  area,  will  cause  an  in- 


246  DISEASES    OF    WOMEN. 

terstitial  death  and  ultimate  absorption  of  the  malignant  cells  at  a 
distance  from  the  electrode,  without  destroying  the  connective  tissue 
surrounding  them,  and  that  this  intracellular  lethal  action  is  inde- 
pendent of  and  additional  to  the  ordinary  destructive  action  of  a 
strong  current  in  the  immediate  neighborhood  of  the  electrodes. 

Illustrative  Cases. — The  discovery  of  this  peculiar  action  of  nas- 
cent oxychloride  of  mercury  was  made  while  the  author  was  con- 
ducting the  treatment  of  a  case  of  inoperable  carcinoma  of  the  groin 
in  August,  1893,  by  means  of  a  carbon  electrode  used  as  the  positive 
pole,  which  had  been  the  method  employed  in  a  number  of  cases  of 
carcinoma  of  the  cervix  uteri  with  but  indifferent  results.  The  rapid 
disintegration  of  the  surface  of  the  carbon-ball  instrument  employed 
in  this  particular  case  under  the  heavy  currents  used  suggested  the 
value  of  zinc  cataphoresis,  then  already  in  use  in  endometritis  and 
other  benign  conditions,  and  the  mercury  was  first  applied  to  the  sur- 
face of  the  zinc  to  keep  the  latter  from  adhering  to  the  surface  of 
the  wound  as  it  would  otherwise  do.  But  there  was  an  improvement 
noted  in  the  outer  edge  of  the  growth  at  some  distance  from  the 
electrode  by  the  next  day,  and  this,  coupled  with  the  facts  that  the 
wound  became  rapidly  aseptic  and  that  the  use  of  100  milliamperes 
for  some  minutes  lessened  the  amount  of  mercury  adhering  to  the 
electrode,  showed  that  the  mercury  itself  was  diffused  in  greatest 
amount,  and  suggested  the  immense  advantage  that  might  accrue 
from  the  use  of  such  an  agent.  This  case,  in  which  the  carcinoma 
was  about  three  inches  in  diameter  and  adherent  to  the  great  vessels 
of  the  thigh,  became  much  better  under  prolonged  employment  of 
the  milder  method,  nearly  the  whole  of  the  diseased  area  filling  in 
with  healthy  granulations  and  the  gentleman  regaining  the  power  to 
walk;  but  it  was  unfortunately  impossible  to  eradicate  the  cancerous 
infiltration  of  the  femoral  artery  and  vein,  and  the  termination  was 
ultimately  fatal. 

This  case,  together  with  the  following  seven  cases,  taken  from 
the  paper  read  before  the  Section  of  Practice  of  Medicine  of  the 
American  Medical  Association  in  June,  1897,  represent  the  author's 
experience  in  the  first  series  of  cases  to  that  date,  though  only  a 
portion  of  them  occurred  in  the  practice  of  gynecology. 

Case  2.  The  second  case,  and  the  first  apparently  complete  suc- 
cess, was  a  recurrent  sarcoma  of  the  palate,  which  had  been  partially 
destroyed  by  the  writer  by  ordinary  electrolysis  in  1893.     This  man, 


MALIGNANT    GEOWTHS.  247 

W.  H.  h.,  aged  39,  had  been  sent  to  me  by  Drs.  Hemminger  and 
Bixler,  of  Carlisle,  Pa.,  with  a  sarcoma  of  the  left  palatal  arch  fully 
the  size  of  a  goose-egg,  which  he  had  declined  to  have  removed  at 
the  University  Hospital.  Nearly  complete  destruction  with  platinum 
needles  gave  him  comfort  for  a  year,  when  it  was  noticed  that  lumps 
were  redeveloping  in  the  scar.  He  was  at  this  time  (in  189-i)  placed 
on  the  mild  zinc-mercury  method,  which  was  kept  up  daily  for  six 
weeks,  resulting,  after  some  subsequent  treatment,  in  a  disappearance 
of  the  growth. 

Case  3.  The  third  case  treated  by  the  method  was  a  farmer 
from  Salem  County,  N.  J.,  aged  55,  with  an  immense  epithelial  cancer 
of  the  face,  extending  from  the  external  angle  of  the  right  eye  to  the 
under  border  of  the  lower  jaw,  the  functions  of  the  corresponding 
eye  and  ear  being  abolished  and  the  right  ramus  of  the  lower  jaw 
destroyed.  He  was  admitted  to  the  Howard  Hospital  and  an  effort 
was  made  to  change  the  character  of  this  immense  surface  by  the 
milder  method  described,  the  current  not  exceeding  100  milliamperes, 
and  the  treatment  was  kept  up  for  some  months.  As  no  permanent 
change  of  sufficient  magnitude  was  produced,  he  was  finally  sent  home 
in  a  slightly  improved  condition.  I  have  learned  since  that  he  died 
about  a  year  later. 

Case  4.  Mrs. ,  aged  50,  was  sent  to  the  author  by  Dr.  Saylor- 

Brown,  of  Williamsport,  Pa.,  October  8,  1895,  in  a  condition  of  pro- 
found anemia  and  cachexia  from  an  upper-rectal  ulceration  of  twelve 
years'  standing.  She  suffered  from  considerable  pain  in  the  left  groin 
and  had  from  twenty  to  twenty-five  black,  •  foul-smelling  stools  per 
day.  Local  treatment  was  undertaken  with  a  new,  hollow,  rectal  elec- 
trode similar  to  the  gold  electrode  shown  in  Fig.  66,  with  an  olive- 
shajDed  active  surface  consisting  of  mercurialized  zinc,  and  so  con- 
nected -^dth  a  syringe  that  its  insertion  was  facilitated  by  a  cushion 
of  albolene  dilating  the  rectum  ahead  of  the  electrode  bulb.  A  con- 
striction was  encountered  about  six  inches  from  the  anus  which 
was  extremely  sensitive.  From  40  to  100  milliamperes  were  employed 
with  mercuric  cataphoresis.  After  several  applications  a  piece  of 
tumor-tissue  came  away  about  the  size  of  the  last  joint  of  the  little 
finger  and  was  sent  to  Dr.  Alfred  Stengel  for  microscopic  examina- 
tion, who  pronounced  it  carcinoma.  A  large  number  of  such  pieces 
came  away  subsequently,  and  after  a  prolonged  treatment  she  was 
sent  home  considerably  improved  in  weight  and  general  health,  with 


248  DISEASES    OF    WOMEN. 

the  greater  portion  of  the  ulceration  healed  over,  and  having  not  more 
than  two  or  three  stools  per  day. 

Case  5.   The  fifth  case,  Mrs. ,  aged  36,  of  Muncie,  Ind.,  came 

under  my  care  March  3,  1896,  with  a  recurrent  sarcoma  of  the  left 
pectoral  muscles  about  3x4  inches  in  superficial  extent  and  appar- 
ently pressing  upon  the  brachial  plexus  and  the  blood-vessels  of  the 
arm,  for  the  left  arm  was  swelled  and  the  seat  of  constant  pain.  Less 
than  two  years  before,  in  July,  1894,  the  left  breast  had  been  re- 
moved by  a  distinguished  surgeon  in  the  West.  This  case  would  have 
been  an  excellent  one  for  the  stronger  method  described,  which  had 
not  yet  been  developed.  An  opening  was  made  in  the  skin  and  a 
zinc-mercury  electrode  inserted  daily  with  about  100  milliamperes, 
under  cocaine,  cataphorically  applied.  After  a  number  of  applications 
the  swelling  and  pain  in  the  arm  disappeared,  and  later  a  piece  of 
the  sarcomatous  tissue  came  away  about  2-^x1  inches  in  size  and 
resembling  a  piece  of  sponge  filled  with  cheesy  material,  and  the 
wound  was  in  a  fair  way  to  heal.  Unfortunately,  acute  mania  devel- 
oped at  this  time,  the  patient's  mental  condition  having  been  sus- 
piciously exalted  for  some  time  before  admission,  compelling  her  hus- 
band to  take  her  home,  where  the  acute  mental  affection  terminated 
fatally. 

Case  6.  Mrs.  A.,  aged  51,  of  Salem,  N.  J.,  came  under  my  care 
in  June,  1896,  suffering  apparently  from  general  prostration.  In 
searching  for  the  cause  I  found  a  suspicious  ulceration  of  the  os 
uteri,  the  cervix  being  enlarged,  hard,  and  very  irregular  in  outline 
and  badly  ulcerated,  exuding  considerable  discharge  characteristic  of 
carcinoma.  Suspecting  malignancy,  I  at  once  conferred  with  her  hus- 
band and  suggested  the  new  treatment.  He,  however,  decided  to  take 
her  elsewhere  for  additional  counsel.  A  week  later  he  brought  his 
wife  back  to  me,  saying  that  he  had  taken  her  to  Professor  Parvin, 
who  concurred  in  the  diagnosis  of  carcinoma  and  advised  curettement, 
to  be  followed  later,  possibly,  by  removal  of  the  uterus.  Being  still 
dissatisfied,  the  patient  was  taken  to  a  homeopathic  physician,  who 
also  pronounced  the  affection  carcinoma,  Imt  proposed  that  the  pa- 
tient come  under  his  care  for  electric  treatment.  This  latter  sug- 
gestion caused  the  gentleman  to  bring  his  wife  back  to  me,  and  she 
was  placed  on  mild  daily  applications  of  the  mercurial  cataphoresis 
with  currents  varying  from  50  to  100  milliamperes  applied  by  the 
smaller-size  zinc  electrode  of  the  set  shown  in  Fig.  26,  with  the  shank 


MALIGNANT    GROWTHS.  249 

curved  somewhat.  The  duration  of  each  application  was  under  ten 
minutes.  This  active  treatment  was  continued  for  about  six  weeks, 
the  local  conditions  improving  rapidly,  when  she  was  sent  home  to 
return  for  an  application  three  times  a  month.  This  was  changed 
later  to  once  a  month. 

The  uterus  is  now  normal  (February,  1898),  the  diseased  area 
being  completely  healed  and  general  health  restored.  By  appoint- 
ment she  was  taken  to  Professor  Parvin  to  verify  her  restoration  to 
health  on  the  28th  of  May,  1897. 

Case  7.  Mrs.  P.,  aged  70,  is  now  under  treatment  at  the  dis- 
pensary of  the  Howard  Hospital  for  carcinoma  of  the  cervix  of  the 
scirrhous  variety.  The  cervix  had  practically  disappeared  by  erosion 
when  the  treatment  was  begun  in  the  fall  of  1896  and  the  patient 
suffered  from  frequent  hemorrhages,  continuous  watery  discharge,  and 
hypogastric  pain.  The  uterus  was  fixed  and  the  vagina  atrophied, 
shortened,  and  surrounded  by  unyielding  walls.  Under  mild  intra- 
eervical  applications  with  a  small  zinc-mercury  electrode  the  hemor- 
rhages ceased,  pain  became  infrequent,  the  discharge  lost  its  offensive 
odor  and  nearly  ceased,  and  a  cachectic  condition  has  been  replaced 
by  relative  health.  The  rigidity  of  the  shortened  and  narrowed  va- 
gina continues,  but  the  whole  mass  can  now  be  slightly  moved.  The 
patient  is  still  under  treatment. 

Case  8.  Mrs.  E.  M.,  aged  47,  came  under  by  care  at  the  Howard 
Hospital  in  the  autumn  of  1896,  and  was  the  first  case  operated  upon 
by  the  stronger  method.  A  tumor  existed  in  the  scar-tissue  and  skin 
at  the  site  of  the  right  breast,  the  breast  having  been  removed  by  a 
surgeon  at  the  Hospital  of  the  University  of  Pennsylvania  about  three 
years  previously  for  carcinoma.  The  tumor  was  about  the  size  of  a 
half  of  an  orange.  The  glands  of  the  axilla  were  normal  and  had 
not  been  removed  at  the  operation. 

An  attempt  was  at  first  made  to  arrest  the  growth  by  the  milder 
method,  but,  this  appearing  too  slow,  the  tumor  was  operated  upon 
by  zinc-mercuric  cataphoresis  with  1000  milliamperes  at  the  hospital 
on  May  3,  1897,  in  the  presence  of  Drs.  A.  E.  Eoussel,  E.  P.  Bernardy, 
and  the  hospital  residents.  The  tumor  at  this  time  had  increased 
considerably  since  first  seen,  measuring  3-|  x  3f  inches.  In  this  ap- 
plication, the  negative  electrode,  a  moistened  disk,  was  also  placed  on 
the  tumor,  making  the  application  bipolar. 

An  immediate  blanching  and  shrinkage  of  the  growth  was  noted, 


250  DISEASES    OF    WOMEN. 

with  the  production  of  small  necroses  at  the  site  of  each  electrode  and 
in  the  centre.  At  the  end  of  thirteen  minutes  the  current  was  turned 
off,  the  electrodes  withdrawn,  a  dry  dressing  ajjpHed  with  iodoform 
dusted  over  the  surface,  and  the  patient  put  to  bed.  The  sloughs 
separated  painlessly  in  ten  days,  leaving  an  apparently  healthy  granu- 
lating surface,  but  before  this  time  the  interesting  fact  was  noted 
that  the  tissues  between  the  electrodes  that  had  been  elevated,  hard, 
vascular,  and  purplish  with  malignancy,  but  had  not  become  ne- 
crosed, were  now  level  with  the  surrounding  surface,  soft,  and  pos- 
sessed of  a  healthy  pink  color;  showing  that  aw  influence  or  substance 
passed  between  the  electrodes  capable  of  destroying  the  cancer-cells  that 
was  unable  to  devitalize  the  normal  tissues  containing  them.  All  evi- 
dence of  malignancy  had  disappeared  except  at  one  spot,  about  the 
size  of  a  marble,  that  was  unquestionably  abnormal,  and  another  spot 
that  appeared  doubtful. 

At  the  end  of  a  month  these  two  remaining  spots  were  subjected 
to  a  second  application  under  ether,  this  time  strictly  monopolar,  with 
the  negative  pads  on  the  abdomen  and  back.  Five  hundred  milliam- 
peres  were  applied,  divided  between  five  zinc-mercury  lancet  elec- 
trodes, in  the  presence  of  a  number  of  physicians  in  attendance  on  the 
meeting  of  the  Americal  Medical  Association  then  in  session  in  Phila- 
delphia. The  cup-shaped  depressions  that  resulted  when  these  ne- 
croses separated  seemed  to  include  all  that  had  been  malignant,  the 
surrounding  flesh  being  soft  and  normal;  but,  while  they  were  filling 
with  healthy  granulations,  internal  metastasis,  of  probably  earlier 
formation,  carried  the  patient  off. 

The  methods  here  described  Jiave  since  been  applied  success- 
fully to  the  following  cases: — 

W.  0.,  aged  39,  an  employee  of  a  sugar-refinery  in  Philadelphia, 
applied  for  treatment  late  in  October,  1897,  suffering  from  a  sarcoma 
of  the  superior  maxilla,  which  caused  protrusion  of  that  side  of  the 
face  and  projected  into  the  mouth,  having  caused  four  teeth  to  pain- 
lessly fall  out.  The  case  had  been  seen  by  Dr.  Hearn  and  by  a  sur- 
geon at  the  Medico-Chirurgical  Hospital,  both  of  whom  diagnosed  sar- 
coma, and  advised  removal  of  the  whole  upper  jaw.  On  October  27, 
1897,  he  was  placed  under  ether,  and  300  milliamperes  applied  for 
fifteen  minutes,  with  mercury  abundantly  supplied  from  a  gold  elec- 
trode. I  was  kindly  assisted  by  Dr.  Bernardy  in  this  case,  whose  in- 
terest in  the  subject  has  been  most  unselfish.     The  result  of  this 


MALIGNANT    GROWTHS.  1^51 

application  was  less  perfect  than  it  would  have  been  with  a  longer 
duration,  and  it  was  found  that  but  one-half  of  the  tumor  was  favor- 
ably affected.  Ofhce  applications  were  begun  four  days  later  with 
an  amalgamated-zinc  electrode;,  which  could  be  painlessly  thrust  into 
the  tumor  without  any  form  of  anesthesia,  though  currents  of  more 
than  40  milliamperes  were  unbearable.  As  these  latter  applications 
seemed  to  have  an  adequate  effect  on  the  remaining  portion  of  the 
tumor,  they  were  continued  thrice  weekly  for  two  months,  during 
which  time  the  sarcomatous  tissue  showed  a  decrease  that  was  per- 
ceptible daily,  both  in  loss  of  substance  and  encroachment  of  the  sur- 
rounding normal  tissue.  At  the  end  of  two  months  all  malignant 
tissue  had  disappeared,  leaving  a  cavity  that  was  quite  narrow,  con- 
sidering the  size  of  the  growth,  and  which  has  since  grown  progress- 
ively smaller.  A  cachectic  color  that  the  patient  presented  when  first 
seen  has  been  replaced  by  the  ruddy  hue  of  health. 

A  lady  of  66,  who  had  had  the  right  breast  removed  in  January, 
1897,  presented  evidence  of  recurrence  in  the  line  of  a  lymphatic 
vessel  in  October  of  the  same  year.  On  the  11th  of  December  she 
was  placed  under  ether,  and  three  small  amalgamated-gold  electrodes 
inserted,  through  which  mercury  was  injected  and  cataphorically  dif- 
fused by  500  milliamperes  for  fifteen  minutes,  with  the  kind  assist- 
ance of  her  physician.  Dr.  Ida  E.  Eichardson  and  Dr.  W.  C.  Thomp- 
son. At  the  end  of  this  time  all  the  malignant  nodules  were  softened, 
and  a  grayish-white  spot  appeared  at  the  entrance  of  each  electrode. 
The  after-pain  was  considerable  and  lasted  about  two  days,  but  there 
was  no  further  pain  during  the  period  of  healing,  and  there  is  now 
a  normal  cicatrix  without  evidence  of  remaining  infection. 

The  most  recent  case  was  that  of  a  woman  of  56  who  presented 
herself  with  an  ulcerated  carcinoma  of  the  sublingual  salivary  gland. 
The  tumor  was  growing  rapidly  and  gave  rise  to  excruciating  pain, 
the  progressing  involvement  of  the  tongue  preventing  the  swallowing 
of  solids.  She  was  placed  under  ether  on  December  28,  1897,  with 
the  kind  assistance  of  Dr.  S.  J.  Gittelson,  and  400  milliamperes  were 
employed  with  a  gold  electrode  and  mercury  for  half  an  hour.  A 
horrible  odor  that  had  been  emitted  from  the  growth  disappeared 
during  the  operation  and  never  returned,  in  spite  of  the  fact  that  the 
whitish  slough  produced  did  not  separate  entirely  until  the  expiration 
of  three  weeks.  The  edges  of  the  excavation  cicatrized  shortly  after- 
ward, and  she  is  now  well  in  every  respect.     The  intense  radiating 


2o2 


DISEASES    OF    WOMEN. 


pain  from  which  she  suffered  disappeared  about  four  hours  after  the 
application  and  never  returned. 

Corroboration  of  these  results  has  been  afforded  by  the  inde- 
pendently conducted  observations  of  Dr.  J.  McFadden  Gaston,  of 
Atlanta,  Ga.,  who  reported  a  successful  case  of  sarcoma  somewhat 
similarly  treated  at  the  meeting  of  the  American  Surgical  Association 
at  AVashington  in  May,  1897. 


^'nliiicus 


Os^^t^US 


Fig.  69. — Outlines  of  circumference  of  sarcoma  in   Dr.  ilcFadden 
Gaston's  case. 


With  Dr.  Gaston's  kind  permission  I  give  the  details  of  this 

case  from  his  paper^  in  an  abbreviated  form.    A  boy  of  12  presented 

a  sarcoma  in  the  hypogastric  region  of  the  size  represented  in  the 

outer  line  of  Fig.  69.     Dr.  J.  B.  S.  Holmes,  of  Atlanta,  made  an 

•exploratory  inci.«ion,  but  found  that  the  adhesions  to  the  surround- 


'  Annals  of  Surgery,  August,  1897. 


PLATE  XXI. 


Carcinoma  of  the  Cervix  Uteri 


BUM  a  ),fcrErnnDGE  ca  imt  r 


MALIGNANT    GROWTHS.  253 

ing  tissues  were  too  great  to  permit  of  its  removal.  He  was  after- 
ward seen  by  Dr.  Hunter  McGuire,  of  Richmond^  who  had  a  specimen 
removed  and  examined  microscopically  by  Dr.  M.  D.  Hoge,  Jr.,  the 
latter  pronouncing  it  a  small,  round-celled  sarcoma.  A  radical  opera- 
tion was  again  declined.  He  was  turned  over  to  Dr.  Gaston  on  JSTo- 
vember  16,  1895,  who  had  not  seen  my  publications  on  the  subject 
at  this  time.  Dr.  Gaston  at  first  used  simple  electro-puncture  with 
positive  needles  around  the  base  of  the  growth  with  a  negative  sponge 
electrode  on  the  opposite  margin.  This  was  repeated  on  alternate 
days,  but  was  later  changed  to  the  cataphoric  administration  of  Don- 
ovan's solution, — the  double  chloride  of  arsenic  and  mercury, — the 
solution  being  placed  on  the  positive  sponge  electrode  and  the  needles 
being  now  negative.  The  absence  of  a  milliamperemeter  rendered 
the  exact  dosage  uncertain,  but  dependence  was  placed  on  the  local 
effect  at  the  negative  needles  in  increasing  or  decreasing  the  number 
of  cells  used  as  the  cells  varied  in  freshness  of  charge.  Minute  vesica- 
tions alternating  with  pits  were  noted  where  the  solution  was  applied 
and  the  usual  evolution  of  hydrogen  at  the  negative  needles. 

The  progressive  shrinkage  is  best  realized  by  a  reference  to  the 
figure,  which  is  copied  from  Dr.  Gaston's  paper.  He  reports  the  pa- 
tient entirely  cured  and  well  on  May  31,  1897. 

It  should  be  added  that  Donovan's  solution  was  given  with  other 
alteratives  by  mouth  during  the  cataphoric  treatment. 

Technique  of  the  Author's  Method  for  Carcinoma  of  the  Portio 
Vaginalis.- — In  my  own  method  for  the  treatment  of  carcinoma  of 
the  cervix  uteri  a  bulbous  electrode  of  zinc,  freshly  amalgamated  with 
mercury,  of  a  size  nearly  filling  the  ulcerated  cavity  if  small,  is  em- 
ployed as  a  monopolar  positive  pole,  the  negative  pole  being  two 
pads  of  suitable  material  covering  the  abdomen  and  back  and  both 
connected  with  the  negative  binding-post.  The  pads  being  in  place, 
the  patient  lying  in  the  dorsal  position  on  the  dorsal  pad,  the  active 
pole  is  passed  into  position  without  other  preparation  of  the  patient 
than  a  simple  daily  antiseptic  douche,  for  the  method  is  itself  power- 
fully antiseptic  in  effects.  Preparatory  curettcment  is  very  rarely 
performed  except  to  remove  manifestly  necrotic  shreds  or  masses,  as 
it  is  unnecessary  with  the  method  and  wasteful  of  blood  and  strength. 
The  zinc  bulb  may  be  about  two  centimetres  long  and  of  a  size  to 
fit  the  cavity,  all  portions  not  touching  the  diseased  area  being  freshly 
covered  Avith  fused  hard  rubber  or  shellac.     If  no  cavitv  exists,  as 


254  DISEASES    OF    WOMEN. 

in  cauliflower  excrescence,  the  most  prominent  portion  of  the  tumor 
is  to  be  destroyed  by  needles  and  simple  bipolar  electrolysis,  for  which 
two  needles,  the  positive  of  platinum  (or  of  zinc),  are  inserted  into 
it.  For  a  case  of  this  nature  the  author  devised  the  double  bipolar 
instrument  (Fig.  70),  the  two  prongs  per  pole  increasing  the  current 
by  lessening  the  local  resistance  and  insuring  more  rapid  progress. 
In  all  cases  the  monopolar  zinc-amalgam  applications  are  finally 
relied  upon  to  complete  the  destruction  of  the  cancerous  margins  and 
prolongations  by  repeated  applications,  extending  over  months  if 
necessary,  until  the  physiologic  activity  of  the  surrounding  tissues 
is  regained,  and  healthy  granulation  tissue  replaces  the  morbid 
growth.  The  current-strength  required  varies  from  50  to  200  mil- 
liamperes,  the  insensitive  nature  of  the  uterus  frequently  permitting 
the  latter  strength  to  be  attained  without  anesthesia.     The  duration 


Fig.   70. — Double,   bipolar   instrument  for  electrolytic   destruction 
within  a  cavity. 


of  the  applications,  which  should  be  daily  or  triweekly,  may  vary  from 
ten  minutes  to  a  half-hour,  every  consideration  uniting  in  urging  a 
rapid  prosecution  of  the  work.^ 

When  observed  in  a  superficial  carcinoma  the  immediate  result 
of  the  application  indicates  a  lessened  hyperemia  of  the  growth;  a 
light-gray  pellicle  forms  about  the  spot  touched  by  the  electrode, 
which  comes  away  at  the  end  of  a  few  days,  leaving  the  superficies 
of  the  growth  somewhat  shrunken.  Under  daily  repetition  of  the 
process  the  cavity  formed  by  the  destruction  of  tissue  becomes  larger, 
but  the  reduction  in  the  size  of  the  growth  is  greater  than  would 
merely  correspond  with  this  destruction  of  tumor-substance,  for  the 
periphery  will  be  found  to  be  shrinking,  the  soft,  normal  tissue  en- 
croaching on  the  indurated  edges.     The  applications  must  be  con- 


'I  am  now  testinp:  the  advisability  of  employing  ferric  cataphoresis  from 
iron  electrodes,  with  the  strong  currents  mentioned,  in  prolonged  treatment. 


MALIGNANT    GKOWTHS.  255 

tinned  until  tlie  cavity  is  surrounded  only  by  normal  edges  of  but- 
slightly-indurated  tissue,  the  determination  of  the  point  when  the 
margins  are  found  to  be  healthy  being  a  matter  of  delicate  judgment. 

The  cavity  and  the  sanious  discharges  issuing  from  it  during 
active  treatment  are  nearly  aseptic  and  odorless  by  reason  of  the 
antiseptic  character  of  the  nascent  oxychlorides  of  zinc  and  mercury 
which  have  united  with  the  superficial  necrosed  tissue;  but  antiseptic 
douches  should  be  directed  as  an  assistant  in  maintaining  an  odor- 
less condition.  Healing  is  to  be  prevented  by  frequent  treatments 
until  the  physician  is  assured  that  the  last  vestige  of  lowly-organized 
cells  has  been  destroyed  and  the  normal  trophic  condition  of  the 
part  restored. 

This  method  is,  of  course,  only  applicable  in  strictly  local  car- 
cinoma or  sarcoma,  extension  to  other  portions  of  the  body  by  means 
of  lymphatics  or  veins  rendering  it  a  palliative  only.  Since  when  em- 
ployed in  any  case  it  quickly  lessens  pain  and  promptly  checks  hemor- 
rhage, its  value  as  a  palliative  in  incurable  cases  is  nevertheless  evi- 
dent. Where  the  strictly  local  tumor  is  of  large  size  and  capable 
of  being  removed  by  the  knife,  it  may  be  better  to  do  so,  and  reserve 
this  method  for  subsequent  employment  on  the  first  reappearance  of 
the  growth  in  the  cicatrix  of  the  operation. 


CHAPTEK  XIX. 
Benign  Tumors  of  the  Breast. 

The  mammary  organs  of  women  are  subject  to  inflammatory 
indurations  and  adenomatous  growths  that  simulate  malignant  tumors 
and  often  cause  grave  anxiety.  A  presumptive  diagnosis  of  benignity 
is,  however,  often  possible  by  a  careful  consideration  of  the  symp- 
toms, among  those  favorable  to  benignity  being  the  youth  of  the 
patient,  distinct  evidences  of  inflammatory  reaction,  tenderness,  slow 
growth,  and  non-adherence  to  the  overlying  skin.  What  might  be 
termed  a  chronic  lobular  mastitis  is  probably  the  most  painful  form 
of  tumor  of  the  breast,  presenting  a  nodule  from  the  size  of  a  hazel- 
nut to  that  of  a  considerable  portion  of  the  gland,  which  is  tender 
to  the  touch  and  the  seat  of  a  constant  ache.  Such  tumors  are 
most  frequently  found  in  young  women,  both  married  and  single, 
and  are  often  in  close  sympathetic  relation  with  disordered  menstrua- 
tion or  even  ovarian  congestion. 

These  painful  inflammatory  indurations  are  particularly  amenable 
to  external  galvanic  and  faradic  applications,  particularly  the  former, 
the  tenderness  and  unpleasant  sensations  yielding  to  a  few  applica- 
tions and  complete  resolution  ultimately  occurring.  The  necessity 
for  prompt  treatment  is  accentuated  by  the  possibility  of  the  inflam- 
matory condition  proving  a  favorable  seat  and  stimulus  for  the  devel- 
opment of  a  previously  existing  malignant  matrix. 

The  application  is  made  with  the  patient  reclining  upon  a  dorsal 
pad  of  large  size,  the  active  pad,  which  is  preferably  negative  and  of 
a  size  equal  to  the  induration,  being  pressed  over  the  latter.  This 
pad  should  be  very  moist  and  well  soaped,  and  may  be  slowly  rotated 
to  lessen  the  action  on  the  skin,  the  latter  being  kept  in  good  condi- 
tion for  painless  transmission  of  effective  currents  by  being  bathed 
daily  with  alcohol.  Gentle  massage  in  the  direction  of  the  lacteal 
ducts  will  assist  the  treatment. 

Skene,  in  a  work  which  deserves  to  be  regarded  as  a  pioneer 
treatise  on  the  science  of  medical  gynecology  as  contrasted  with  the 
(256) 


BENIGN    TUMORS    OF    BKEAST.  257 

merely  surgical  treatises  that  have  preceded  it,  describes  a  probably 
similar  condition  under  the  name  of  "areolar  hyperplasia  of  the  mam- 
mary glands."^  With  the  exception  of  the  first  case,  in  which  the 
breast  was  removed,  some  twenty-three  instances  had  been  observed 
by  him,  and  all  recovered  under  medical  treatment  without  resort 
to  surgery.  How  many  of  these  cases  would  have  preserved  their 
breasts  in  less  conservative  hands?  In  all  such  cases  the  suspicion 
of  malignancy,  either  present  or  prospective,  would  have  been  suffi- 
cient to  warrant  ablation  at  the  hands  of  surgical  enthusiasts,  and  an 
inflation  of  the  statistics  of  non-recurrent  malignancy  would  have 
surely  resulted.  These  cases  are,  of  course,  not  tumors  in  the  path- 
ologic sense. 

The  most  common  benign  tumor  of  the  breast  is  the  adenoma, 
which  is  usually  found  as  a  small,  hard  lump  from  the  size  of  a  pea 
to  that  of  a  walnut.  They  may  be  multiple,  and  differ  from  both 
chronic  lobular  mastitis  and  malignant  tumors  by  having  a  limiting 
membrane  and  being  movable.  They  are  apt  to  be  more  tender  than 
a  malignant  tumor. 

Such  a  tumor  is  easily  removed  by  a  surgical  operation  for 
enucleation,  leaving  the  breast  largely  intact  and  without  risk  of 
recurrence;  yet  if  the  patient  is  averse  to  this  there  are  two  electric 
procedures  available:  either  simple  percutaneous  galvanic  applica- 
tions or  percutaneous  iodine  cataphoresis  (by  Avhich  the  growth  is 
arrested  by  stimulating  the  physiologic  resistance  of  the  surrounding 
tissues,  removing  pain,  and  lessening  the  growth)  or  by  puncture  and 
simple  negative  electrolysis. 


^"Medical  Gynecology:  a  Treatise  on  the  Diseases  of  Women  from  the 
Stand-point  of  the  Physician,"  by  A.  J.  C.  Skene.  M.D.,  page  355.  D.  Appleton 
&  Co. 

17 


CHAPTEK  XX. 

Diseases  of  the  Urethra,  Bladder,  Kectum.  and  Sigmoid 

Flexure. 

diseases  of  the  urethra  and  bladder. 

Caruncle. — This  little  tumor  of  the  urethral  orifice,  which  often 
gives  paiu  and  discomfort  out  of  all  proportion  to  its  size,  may  be 
eradicated  by  several  electric  methods,  after  it  has  been  temporarily 
anesthetized  by  the  cataphoric  application  of  a  cocaine  solution.  The 
cocaine  should  be  applied  on  a  cotton  pledget  saturated  with  the 
solution  and  held  on  the  part  by  a  carbon  or  platinum  electrode, 
positive,  with  5  to  15  milliamperes  for  some  minutes,  the  negative 
indifferent  pad  being  on  the  abdomen.  If  the  growth  is  pedunculated 
the  galvano-cautery  loop  may  then  be  passed  over  it  and  the  heat 
turned  on  as  it  is  tightened.  A  sessile  growth  is  best  destroyed  by 
negative  puncture,  followed,  at  the  same  sitting,  by  a  small  positive 
zinc-amalgam  electrode  pressed  into  the  opening  thus  made;  10  to 
15  milliamperes  will  be  sufficient. 

Stricture  or  Ulcerations  of  the  Urethra. — The  treatment  of 
strictures  or  ulcerations  of  the  female  urethra  is  as  successfully  ac- 
complished as  in  the  male  and  much  more  readily  managed.  The 
negative  pole  is,  of  course,  necessarily  the  active  one,  as  we  wish  a 
relaxing  and  softening  effect,  the  electrode  being  the  same  as  em- 
ployed in  the  anterior  urethra  in  males,  having  straight  shanks  with 
bulbs  of  different  sizes.  When  not  provided  with  these  the  physician 
may  use  the  long-shanked  zinc-amalgam  electrodes  designed  for  intra- 
uterine applications  (Fig.  26)  the  smallest  size  being  usually  appro- 
priate. "\^^len  the  latter  are  used  they  are  best  lubricated  by  mercury, 
but  not  for  cataphoresis,  since  the  negative  pole  is  imperatively  neces- 
sary for  dilatation,  and,  like  all  other  electrodes  to  be  inserted  within 
the  urethra,  should  be  scrupulously  cleaned,  preferably  fire-cleansed, 
before  insertion.  Five  to  8  milliamperes  is  a  sufficient  current- 
strength,  the  current  being  turned  on  when  the  stricture  is  reached, 
(258) 


DISEASES    OF    XliE    BLADDEK    AND    KECTUM.  259 

the  operator  geutly  pressing  the  instrument  forward  until  it  passes 
the  contracted  portion,  then  re-engaging  it  from  behind.  The  pro- 
cedure should  be  repeated  every  three  or  four  days  until  a  cure  is 
accomplished. 

Ulcerations  of  the  urethra  are  best  treated  (as  ulcerations  else- 
where) by  positive  zinc-amalgam  cataphoresis,  very  small  currents  of 
3  or  4  milliamperes  being  sufficient. 

Neuroses  of  the  Urethra  and  Vulva. — Incontinence  of  urine  in 
the  adult  may  be  corrected  by  -a  urethro-abdominal  or  urethro-sacral 
application  of  the  primary  faradic  current,  turned  on  in  the  swelling 
method  for  two  to  five  minutes  daily  or  every  other  day.  In  young 
girls  or  children  the  same  results  can  be  attained  usually  by  external 
pubo-sacral  applications  of  the  same  current  with  ordinary  disk  elec- 
trodes. 

The  treatment  of  painful  or  pruriginous  affections  of  the  vulva, 
urethra,  or  bladder — such  as  pruritus  vulva,  vaginismus,  etc. — is  by 
no  means  so  simple,  though  often  yielding  the  best  results.  "We  must 
here  search  for  an  organic  or  constitutional  basis  for  the  symptoms, 
such  as  erosions,  lithemia,  toxemia,  or  kidney  disease,  to  be  corrected 
simultaneously  wdth  the  appropriate  local  application.  It  needs 
scarcely  to  be  said  that  we  employ  the  high-tension  faradic  current 
for  a  mere  neurosis,  having  in  view  its  anesthetic  effect.  If  this  be 
ineffective  a  weak  solution  of  cocaine  may  be  cataphorically  driven  in 
from  a  covered  carbon  electrode  by  a  few  milliamperes,  the  active 
electrode  being  positive. 

For  neuralgia  of  any  portion  of  the  pelvis  a  vaginal  bipolar  fara- 
dic current  is  usually  effective  with  the  high-tension  coil. 

Atony  of  the  Bladder. — Contractile  and  tonic  effects  may  be 
readily  produced  in  the  functionally  weakened  bladder  by  including 
the  organ  between  the  poles  of  a  vagino-abdominal  application  of 
either  current.  A  quickened  micturition  is,  in  fact,  frequently  noticed 
by  patients  undergoing  this  method  for  other  purposes.  In  the  pa- 
ralysis from  long  distension,  as  in  cases  of  chronic  cystitis,  particu- 
larly when  fatty  degeneration  of  the  muscular  coats  of  the  organ  is 
suspected,  intravesical  applications  of  the  primary  faradic  current 
should  be  made,  and,  if  vesical  irrigation  of  antiseptic  fluids  be  prac- 
ticed, the  current  should  be  applied  simultaneously  by  the  swelling 
method  while  the  bladder  is  ejecting  the  liquid.  This  may  be  done 
by  attaching  a  twisted-wire  socket  for  connection  with  the  battery 


260  DISEASES    OF    WOMEN. 

to  an  ordinary  silver  catheter,  insulating  all  but  the  tip  with  fused 
shellac,  and  employing  it  as  an  electrode.  ^Yhile  the  liquid  is  re- 
gurgitating the  current  will  increase  its  force  perceptibly,  thus  caus- 
incr  contraction  of  the  bladder  under  the  most  favorable  conditions. 
The  irrigation  is  the  only  element  of  this  application  requiring  spe- 
cial discrimination  as  to  frequency,  or  producing  possible  reactions 
from  overuse. 

Cystoscopy. — In  order  that  this  subject  may  receive  the  most 
thorough  and  practical  discussion,  the  author  has  requested  Dr. 
Harris  A.  Slocum,  Professor  of  Gynecology  at  the  Philadelphia  Poly- 
cHnic,  to  prepare  a  statement  which  will  include  the  fruits  of  his  wide 
experience  in  the  examination  of  the  bladder  in  women: — 

G3'necologists  have,  for  some  time,  recognized  the  close  sympto- 
matic relation  of  diseases  of  the  uterus  and  its  appendages  with  those 
of  the  bladder  and  such  parts  of  the  ureter  and  urethra  as  are  in  close 
proximity  to  it.  This  is  probably  due  to  the  fact  that  the  viscera  of 
the  pelvic  cavity  are  supplied  by  the  hypogastric  plexus  of  the  sym- 
pathetic, situated  in  front  of  the  promontory  of  the  sacrum,  between 
the  two  common  iliac  arteries. 

It  may  be  noticed  that  the  three  principal  pelvic  organs  in  the 
female  have  a  similar  nerve-supply.  The  upper  portions  of  the  blad- 
der, uterus,  and  rectum  receive  a  nearly  pure  sympathetic  distribution 
from  the  ovarian  and  inferior  hypogastric  plexuses  of  the  sympathetic. 

Their  movements  are  unconsciously  performed  and  entirely  re- 
moved from  the  domination  of  the  will,  permitting,  in  the  bladder 
and  rectum,  automatic  adaptation  to  varying  amount  of  contents, 
their  retention  during  sleep,  etc.;  in  a  measure,  this  view  also  applies 
to  the  uterus  when  that  organ  is  engaged  in  gestation,  the  sole  object 
of  its  existence. 

The  outlets  of  these  organs  have  a  large  proportion  of  insulated, 
spinal  nerve-fibres.  The  sphincter  ani  receives  filaments  from  the 
hemorrhoidal  branch  of  the  fourth  sacral,  the  bladder  and  urethra 
being  supplied  from  the  third  and  fourth  sacral,  and  the  cervix  the 
same.  These  introduce  the  elements  of  control  or  inhibition  to  the 
exit  .of  each  excretory  organ  (parturition  is  a  modified  excretion),  more 
marked  in  the  bladder  and  rectum,  while  evidently  not  at  all  volitional 
in  the  cervix. 

The  inhibitory  function  of  the  spinal  element  in  the  uterus  is 
exerted,  as  before  indicated,  in  the  resistance  offered  by  the  cervix  to 


DISEASES    OF    THE    BLADUER    Ais'D    KECTUAI.  361 

the  rhythmic  contractions  of  the  uterine  muscle  during  gestation,  and 
is  probably  the  chief  reason  for  their  presence  in  that  part  of  the 
organ. 

It  is  the  intimate  relation  of  the  nervous  and  vascular  supply  of 
the  pelvic  tissues  that  contributes  mainly  to  their  close  symptomatic 
relationship;  the  rectum,  as  well  as  the  bladder,  frequently  requiring 
investigation  in  seeking  the  cause  for  symptoms  apparently  uterine. 

The  purpose  of  this  contribution  is  to  give  a  brief  description  of 
the  ordinary  methods  of  examining  the  bladder  as  applied  to  office 
practice,  and  will  not  deal  with  diagnosis  or  treatment. 

Two  methods  of  investigation  are  available:  the  indirect  and 
the  direct.  In  the  former  the  view  of  the  bladder  is  obtained  through 
Nitze  and  Leiter's  cystoscope,  which  consists  of  an  angled  tube  resem- 
bling a  urethral  sound,  about  twenty-one  millimetres  in  circum- 
ference. The  tip  of  the  instrument  contains  a  tiny  electric  light 
behind  a  window  of  quartz.  At  the  recedent  angle  within  the  tube 
is  a  prism  so  placed  that  the  rays  received  from  the  bladder-wall  are 
reflected  through  a  telescope  to  the  eye  of  the  examiner.  After  con- 
necting the  rheophores,  contact  is  made  and  broken  by  means  of  a 
milled  screw  placed  conveniently  to  the  forefinger. 

Several  modifications  of  this  instrument  have  been  devised, 
among  which  may  be  mentioned  that  of  Skeene's,  in  which  a  ureteral 
catheter  may  be  used  and  the  ureters  catheterized  while  under  in- 
spection. 

In  examining  the  bladder  by  this  method,  with  the  patient  in 
the  dorsal  position,  its  interior  is  cleansed  of  mucus,  pus,  or  blood 
if  present,  and  filled  with  a  warm,  weak  boric-acid  solution,  using  a 
four-ounce  glass  or  hard-rubber  funnel,  two  feet  of  rubber  tubing 
connected  by  a  glass  tube  two  inches  in  length  with  the  catheter  to 
be  used.  Erom  four  to  eight  ounces  are  necessary,  according  to  the 
capacity  of  the  bladder. 

It  requires  a  certain  amount  of  experience  with  this  instrument 
to  obtain  a  correct  impression  of  what  is  seen.  The  appearance  of 
the  area  inspected  varies  with  the  distance  of  the  prism  from  the 
bladder-wall.  At  5  millimetres  it  is  magnified  to  nearly  twice  the 
normal  size;  at  20  millimetres  it  is  less  than  normal,  while  at  15  mil- 
limetres the  view  obtained  about  represents  the  true  size  of  lesions 
as  they  exist.  This  distance  is  approximately  secured  by  allowing 
the  tip  to  touch  the  bladder-wall,  and  then  withdrawing  just  suf- 


262 


DISEASES    OF    WOMEN. 


ficiently  to  clear  it.  Contact  between  instrument  and  bladder  should 
otherwise  be  avoided,  as  the  heat  generated  after  three  to  five  minutes' 
use  is  sufficient  to  burn  painfully,  and  might  give  rise  to  a  cystitis  that 
had  not  previously  existed. 

Rather  than  continue  a  long,  uninterrupted  examination,  it  is 
far  safer  to  shut  off  the  current  for  half  a  minute  after  three  to  five 
minutes'  use,  and  allow  the  instrument  to  cool. 

The  second,  or  direct,  method — described  by  Pawlik  and  Kelly — 
is  far  more  satisfactory  in  examining  the  bladder  in  the  female.  The 
speculum  is  a  straight,  metallic  tube  nearly  10  centimetres  in  length, 
made  in  sizes  of  from  5  millimetres  to  21  millimetres  in  diameter, 


Fig.  71. — Cystoscope  of  J.   Howard   Kelly. 


with  a  flaring  proximal  extremity,  a  handle  placed  at  an  obtuse  angle, 
and  an  obturator,  snugly  fitted,  to  facilitate  introduction. 

When  necessary,  the  urethra  is  dilated  with  Kelly's  steel  urethral 
dilators  or  his  calibrator:  a  spherically-handled  metallic  cone  7.7 
centimetres  in  length,  4  millimetres  in  diameter  near  the  apex  and  16 
millimetres  at  the  base,  and  graduated  at  each  2-millimetre  increase 
in  diameter.  For  office  use  or  ordinary  examination  the  9-millimetre 
and  10-millimetre  sizes  are  sufficient.  The  bladder-wall  is  easily  ex- 
amined through  them,  and  they  rarely  require  a  preliminary  dilatation. 

Other  instruments  required  are:  one  or  two  urethral  catheters, 
an  aluminium  applicator,  and  an  appliance  for  removing  accumulating 
urine. 

One  of  three  positions  may  be  chosen   in   wliich    to   place  the 


DISEASES    OF    THE    BLADDER    AND    RECTUM.  263 

patient:  Sims's  position;  the  dorsal,  with  extreme  elevation  of  the 
hips,  and  flexion  of  thighs  and  legs;  and  the  knee-chest  position. 
The  latter  is  generally  to  be  preferred;  it  is  quickly  attained  and 
permits  the  maximum  of  ballooning. 

Corsets,  bands,  and  all  sources  of  constriction  must  be  loosened, 
and  the  patient  instructed  to  breathe  freely  and  gently,  not  forcing 
the  air  from  the  lungs. 

The  bladder  should  be  thoroughly  emptied  before  introducing 
the  speculum,  and  voluntary  voiding  generally  clears  it  of  all  fluid. 

After  having  observed  the  preliminary  instructions  regarding  the 
clothing,  the  light  from  the  head-mirror  is  thrown  upon  the  urethral 
opening,  and  the  speculum,  warmed  and  oiled,  is  gently  inserted  in 
the  meatus.  Bear  in  mind  the  slight  curve  to  the  urethra,  and  begin 
the  operation  by  having  the  handle  slightly  depressed  and  the  beak 
pointing  a  degree  upward.    When  it  has  penetrated  for  about  an  inch 


Fig.  72. — Urethral  calibrator. 


or  an  inch  and  a  half,  raise  the  handle  half  an  inch  to  bring  the  instru- 
ment in  the  line  of  the  canal  and  continue  the  introduction.  If  care 
and  great  gentleness  are  observed,  the  operation,  in  the  majority  of 
cases,  with  No.  6  speculum,  is  almost  painless.  The  average  time  con- 
sumed is  one  and  a  half  minutes.  It  must  be  done  slowly,  especially 
in  office-work,  where  the  patient  at  once  goes  from  the  house  to  the 
street. 

The  greatest  amount  of  resistance  will  be  met  just  before  the 
beak  enters  the  bladder,  and  it  is  just  here  that  the  patient  may  first 
complain  of  pain.  The  amount  of  pressure  used  is  hard  to  estimate, 
but  is  probably  two  ounces,  and  this,  with  an  occasional  rotary  move- 
ment, is  sufficient  to  allow  of  the  insertion  of  the  speculum  into  a 
bladder  that  is  tender  and  irritable  from  chronic  inflammation,  with 
a  minimum  amount  of  pain  at  the  time,  and  safety  for  the  patient 
after  she  has  left  the  office. 

The  examination  may  now  be  begun,  bearing  in  mind  that,  in 


264  DISEASES    OF    WOMEN. 

the  majority  of  inflammatory  cases,  the  lesions  will  be  found  on  or 
near  the  floor  of  the  bladder  (the  uppermost  portion  when  in  the 
genu-pectoral  position).  Two  favorite  spots  where  inflammatory 
areas  are  apt  to  be  found  are  directly  in  the  neck  of  the  bladder  (ex- 
amined last,  as  the  tube  is  being  removed),  and  to  either  side  of  the 
neck.  The  latter  can  only  be  seen  by  carrying  the  outer  part  of  the 
speculum  far  over  to  the  side,  at  least  forty-five  degrees  from  the 
median  line.  This,  too,  should  be  done  slowly  and  gently.  Much 
more  can  be  elicited  from  the  tissues  by  gentle  and  persistent  handling 
than  by  a  sudden  force  that  is  apt  to  surprise  them  into  resistance. 

"WKen  there  is  a  tendency  for  the  vagina  to  distend  and  encroach 
upon  the  space  needed  for  the  bladder,  as  is  often  the  case  where  a 
lacerated  or  dilated  perineum  exists,  the  patient  should  gently  strain 
and  expel  the  air  from  the  vagina,  after  the  speculum  has  entered  the 
bladder  and  before  the  obturator  is  removed,  then,  by  pressing  the 


Fig.  73. — Kelly's  urethral  dilator. 


perineum  against  the  anterior  vaginal  wall  and  removing  the  obtura- 
tor, air  enters  the  bladder,  and  its  distension  is  accomplished.  If  the 
ballooning  is  not  satisfactory,  the  bladder  being  held  in  contact  with 
the  end  of  the  speculum,  it  may  be  due  to  holding  the  breath,  strain- 
ing, an  oblique  position  of  the  thighs,  or  a  rigidity  of  the  dorsal  or 
abdominal  muscles.  See  that  the  thighs  are  perpendicular  and  the 
back  well  curved  toward  the  table;  then,  instructing  the  patient  to 
breathe  gently  and  to  avoid  straining,  the  wall  will  generally  fall 
away  from  the  speculum  and  permit  a  full  examination  to  be  made. 
During  the  examination  the  accumulating  drip  from  the  ureters 
becomes  annoying,  surging  up  to  and  filling  the  inner  end  of  the 
speculum  with  each  expiration.  This  may  be  removed  by  Kelly's  ap- 
pliance, consisting  of  a  rubber  tube  50  centimetres  in  length,  with  a 
rubber  ball  at  one  extremity,  and  a  hollow,  perforated,  metallic  sphere 
6  millimetres  in  diameter  at  the  other,  for  introduction  into  the  blad- 
der.   If  the  metal  ball  is  replaced  by  the  long  nozzle  of  a  hard-rubber 


DISEASES    OF    THE    BLADDEE   AKD    RECTUM.  265 

uterine  syringe,  this  little  contrivance  will  be  found  to  answer  the 
purpose  perfectly,  being  more  easily  and  quickly  introduced  and 
removed. 

Dr.  George  E.  Shoemaker  devised  and  reported  an  apparatus  for 
keeping  the  bladder  dry.  He  used  a  quart  bottle  the  cork  of  which 
was  fitted  with  two  rubber  tubes.  Through  one  of  these  the  bottle  is 
exhausted  of  air,  and  to  the  other  is  attached  a  ureteral  catheter, 
which  is  inserted  along  the  wall  of  the  speculum,  is  too  small  to  inter- 
fere with  the  field,  and  readily  removes  the  urine.  He  has  also  had  a 
small  tube  soldered  in  the  lumen  of  the  speculum,  to  the  outer  end 
of  which  the  exhaust  tube  is  attached. 


Fig.  74. — Cystoscopic  syringe. 

If  these  appliances  are  not  at  hand  and  the  urine  accumulates 
rapidly,  a  quick  and  ready  method  of  emptying  the  bladder  is  to  with- 
draw the  speculum  until  the  inner  end  just  reaches  the  neck  of  the 
bladder  (shown  by  the  appearance  of  a  narrow  ring  of  mucous  mem- 
brane at  the  end  of  the  instrument),  and  request  the  patient  to  rise 
from  the  knee-chest  position  to  kneeling.  This  brings  the  inner  end 
of  the  speculum  to  a  plane  below  the  rest  of  the  bladder  and  empties 
it  at  once.  A  short  explanation  to  the  patient  satisfies  her  and  gives 
her  a  moment's  respite  by  changing  her  position.  Another  method 
— the  simplest  of  all — is  to  partly  withdraw  the  tube  and  ask  the 
patient  to  strain  gently.    This  brings  the  acting  floor  of  the  bladder 


266  DISEASES    OF    WOMEN. 

up  to  the  opening,  when  by  gently  depressing  the  mouth  of  the 
instrument  the  desired  object  is  accomplished. 

To  lessen  the  amount  of  urine  excreted,  see  that  the  patient 
drinks  no  fluid  for  an  hour  before  the  examination  is  made. 

It  is  essential  that  the  bladder  should  be  thoroughly  distended, 
not  only  to  open  up  all  hiding-places  for  erosions,  ulcers,  or  other 
lesions,  but  that  the  mucous  membrane  may  be  presented  in  its 
true  colorings.  A  partially-contracted  bladder  is  a  shade  darker  or 
redder  than  when  fully  distended  and  might  easily  mislead  in  esti- 
mating the  degree  of  inflammation.  Several  healthy  bladders  (with 
all  possible  aseptic  precautions)  should  be  previously  examined,  to 
learn  the  appearance  of  the  normal  organ. 

It  is  not  desirable  to  have  the  inner  end  of  the  speculum  too  near 
the  wall.    "Withdraw  from  half  to  two  inches,  according  to  the  degree 


Fig.   75. — Ureteral  searcher. 

of  illumination.  More  of  the  field  is  seen  at  one  glance  and  a  better 
idea  of  relations  secured. 

The  choice  of  light  depends  upon  circumstances.  In  the  office 
the  electric  head-light,  with  a  reliable  Edison-Lalande  or  other 
battery  is  satisfactory,  providing  one  is  fortunate  in  the  selection  of  a 
lamp.  These  may  last  six  months  or  a  year,  or  they  may  be  destroyed 
in  a  few  minutes  without  redress  from  the  dealers.  When  connection 
with  the  battery  is  made  the  highest  resistance  should  be  interposed 
at  first,  to  prevent  a  possible  destruction  of  the  carbon  filament. 
Without  care,  one  may  burn  out  a  lamp  in  an  instant. 

If,  for  any  reason,  the  electric  head-light  and  battery  are  not  to 
be  obtained,  the  light  from  a  good  lamp  or  gas-jet  reflected  from  a 
head-mirror  will  give  satisfactory  results,  and,  finally,  in  the  absence 
of  these,  similarly  reflected  daylight  gives  all  the  illumination  neces- 
sary, and  has  the  advantage  of  presenting  the  parts  in  their  true  and 
easily  recognized  colors.    In  office-work,  therefore,  the  only  essential 


DISEASES    OF    THE    BLADDER    AND    RECTUM.  267 

instruments  are  a  head-mirror,  one  six-millimetre  speculum,  and*  an 
aluminium  applicator.  A  clear  recollection  of  the  nervous  and  vas- 
cular supply  to  the  various  organs  of  this  region  will  go  far  toward 
a  correct  interpretation  of  symptoms,  and  the  intelligent  applica- 
tion of  the  proper  treatment.  One  will  lose  no  time  in  becoming 
thoroughly  acquainted  with  the  essential  and  relative  anatomy  of  the 
parts. 

Applications  through  the  cystoscope  are  best  made  with  a 
slender  aluminium  applicator,  carrying  a  thin  layer  of  cotton  on  the 
end.  Care  should  be  taken  not  to  wrap  too  thickly,  to  avoid  pinching 
a  fold  of  mucous  membrane  against  the  sharp  edge  of  the  tube  when 
withdrawing  the  applicator.  The  latter  may  be  so  thinly,  yet  service- 
ably,  wrapped  with  cotton  that  the  eye  may  follow  it  down  the  ISTo.  9 
tube  to  the  spot  to  be  touched,  thus  confining  the  medicine  to  the  area 
needing  it. 

An  important  feature  in  connection  with  cystoscopy  is  the  exam- 
ination of  the  ureters.  These  pass  diagonally  through  the  wall  of  the 
bladder  and  enter  it  about  1  inch  in  front  of  the  uterine  neck,  and  -J 
to  f  inch  from  the  median  line.  In  order  to  bring  them  into  view, 
the  speculum  should  be  turned  about  thirty  degrees  from  the  median 
axis,  and,  with  the  patient  in  the  genu-pectoral  position,  the  handle 
is  depressed  until  the  mouth  of  the  ureter  is  brought  into  view.  The 
appearance  of  this  opening  is  not  always  the  same,  and  is,  at  first, 
rather  difficult  to  find.  It  may  appear  as  a  small  dimple  with  pouting 
edges,  a  small  slit,  or  an  area  of  deeper  color  than  its  surroundings. 
A  fairly  accurate  guide  is  found  in  the  jet  of  urine  issuing  from  it. 
If  the  kidney  and  ureter  of  the  side  under  observation  are  intact,  a 
small,  shining  line  of  urine  may  be  traced  upward  to  its  emergence. 

In  rare  conditions,  probably  of  unusual  stimulation  of  the 
ureteral  muscular  fibres,  the  mouth  of  the  ureter  is  unexpectedly 
indicated  by  the  appearance  of  a  tiny  stream  of  urine,  such  as  would 
be  projected  from  an  hypodermic  syringe,  forcibly  ejected  across  the 
inner  opening  of  the  speculum,  sometimes  striking  its  lower  wall  with 
a  faintly  audible  tinkle. 

Further  discussion  of  the  examination  of  the  ureters  will  not  be 
entered  upon  here,  but  attention  is  called  to  the  fact  that  inflam- 
mation of  the  lower  end  of  these  tubes  may,  at  times,  be  the  cause  of 
hitherto  obscure  and  persistent  backache,  evidenced  by  the  testimony 
of  the  patient,  when  the  sound  enters  the  canal,  that  there  is  where 


268  DISEASES    OF    WOMEN. 

the  trouble  lies,  and,  afterward,  by  the  disappearance  of  the  symptom 
after  proper  treatment. 

The  color  of  the  mucous  membrane  lining  the  bladder  varies 
very  much  in  different  people,  and  at  different  times  in  the  same  sub- 
ject. It  is  several  shades  darker  for  a  week  before  the  menstrual 
period,  increasing  as  that  time  approaches,  rendering  it  desirable  not 
to  examine  at  that  time,  except  when  the  lesion  is  a  very  light  one. 
It  is  then  better  to  select  that  period,  as  an  area  of  hyperemia  that 
was  not  visible  before,  becomes  plainly  so  during  the  period  of  pelvic 
turgescence.  It  would  be  well,  in  such  a  case,  to  make  tw^o  exami- 
nations: one  a  week  after  the  menses  have  ceased  and  one  the  day 
before  it  is  again  expected.  The  contrast  w'ould  indicate  the  relative 
integrity  of  the  different  capillary  areas. 

The  average  color  of  the  healthy  bladder  is  pale-flesh  color,  with 
occasional  reddish  or  bluish  streaks,  very  fine,  generally  short — not 
over  half  an  inch,  and  sometimes  dichotomous.  These  are  the  small 
veins,  and  are  rarely  altogether  absent.  The  shade  deepens  as  the 
neck  of  the  bladder  is  approached,  and  at  the  sphincter  is  apt  to  be  a 
deep  red,  which  continues  with  gradual  paling  along  the  urethra  to 
within  a  quarter  or  half  an  inch  of  the  ostium,  when  it  reaches  the 
shade  as  seen  without  the  speculum's  aid. 

Let  each  case  be  carefully  and  gently  handled,  both  to  avoid  in- 
juring the  tissues  and  to  reassure  the  patient's  mind.  Frequently 
the  first  attempt  to  examine  an  extremely  nervous  patient  induces 
marked  mental  distress,  and  requires  judgment  as  to  whether  to  con- 
tinue the  efforts  or  wait  until  another  time. 

The  air  contained  in  the  bladder  is  variously  disposed  of.  If 
the  treatment  does  not  extend  to  the  urethra,  use  the  same  procedure 
mentioned  when  speaking  of  the  disposal  of  the  accumulating  urine: 
withdraw  the  speculum  to  the  inner  extremity  of  the  urethra,  place 
a  small  receptacle  under  the  mouth  of  the  instrument,  and  request 
the  patient  to  rise  to  the  kneeling  posture.  Urine  and  air  escape,  the 
bladder  collapses,  and  the  speculum  is  entirely  removed. 

If,  as  is  often  the  case,  the  urethra  likewise  needs  to  be  treated, 
the  application  is  made  during  the  slow  withdrawal  of  the  speculum, 
leaving  the  bladder  distended  with  air.  A  soft-rubber  catheter  may 
easily  be  inserted  and  the  viscus  will  be  emptied  when  the  patient 
either  stands  up  or  lies  down. 

Occasionally,  when  making  applications  at  the  patient's  house, 


DISEASES    OF    THE    BLADDEIt    AND    RECTUM.  269 

the  rubber  catheter  is  permitted  to  remain  in  situ  for  a  variable 
length  of  time:  from  half  an  hour  to  four  hours.  This  prevents  a 
diluting  of  the  medicament,  and  allows  a  longer  period  for  its  action 
upon  the  mucous  membrane,  but  must  be  done  tentatively,  to  avoid 
irritating  it. 

While  it  is  not  desirable  to  have  a  patient  leave  the  office  with 
air  in  the  bladder,  yet,  should  this  occur,  it  rarely  need  cause  anxiety. 
It  is  usually  voided  upon  reaching  home,  with  the  first  attempt  to 
pass  the  urine,  and  is  seldom  followed  by  untoward  results. 

DISEASES  OF  THE  EECTUM  AND  SIGMOID  FLEXURE. 

The  frequency  with  which  the  physician  in  the  practice  of  gyne- 
cology encounters  diseases  of  the  rectum  makes  it  wise  to  add  a  few 
paragraphs  on  these  conditions  in  which  electricity  is  of  signal  service. 
This  is  an  electro-therapeutic  field  that  has  been  much  neglected  in 
spite  of  good  work  that  has  been  occasionally  recorded. 

Anal  Fissure. — In  cocaine  cataphoresis  we  have  an  excellent  and 
almost  painless  method  of  healing  these  troublous  conditions  of  the 
anal  outlet,  which  will  frequently  make  divulsion  of  the  sphincter 
unnecessary.  The  patient  is  placed  in  position  for  examination,  pref- 
erably leaning  forward,  face  downward,  over  the  head-end  of  a  couch, 
and  the  anus  carefully  examined  in  the  light  of  a  head-mirror  or 
electric  head-light.  When  the  painful  erosion  or  fissure  has  been 
found  the  small  pad  is  slipped  under  the  abdomen  and  made  nega- 
tive, while  the  positive  electrode,  of  platinum  or  carbon  covered  with 
absorbent  cotton  dipped  in  a  10-per-cent.  solution  of  cocaine  hydro- 
chlorate  is  applied  to  the  erosion  and  from  1  to  5  milliamperes  turned 
on  for  some  minutes.  Usually  one  application  is  sufficient  to  pro- 
mote healing;  at  any  rate  it  should  not  be  repeated  until  a  sufficient 
time  has  elapsed  to  test  the  possibility  of  healing  having  occurred. 

Hemorrhoids. — Both  external  and  internal  hemorrhoids  are 
readily  and  radically  cured  by  making  use  of  the  coagulative  and 
styptic  action  of  electricity  within  the  pile  by  means  of  puncture. 
Thanks  to  the  anesthetic  value  of  cocaine  cataphoresis  this  procedure 
may  be  made  almost  painless,  and  the  subsequent  discomfort  during 
the  healing  process  is  less  than  by  any  other  method.  The  electric 
method,  while  radical  in  results  and  free  from  danger,  possesses,  there- 
fore, the  advantages  of  being  possible  without  general  anesthesia. 


270  DISEASES    OF    AVOMEX. 

The  patient  being  in  the  position  described  in  preceding  para- 
graphs, the  pile  is  exposed  to  a  good  light,  those  within  the  sphincter 
by  means  of  a  rectal  speculum,  and  a  carbon  or  platinum  electrode 
with  cocaine  solution  on  cotton  applied  as  already  described.  The 
cocaine  electrode  is  made  to  cover  the  most  prominent  portion  of  the 
pile  which  is  intended  to  be  punctured  and  the  material  diffused  by 
anodic  cataphoresis  for  about  seven  minutes  with  a  current  of  15  to 
25  milliamperes  according  to  the  discomfort  produced.  At  the  end 
of  this  time  a  small  platinum  needle  on  a  staff  some  six  inches  long 
(Fig.  76),  insulated  to  a  half-inch  from  the  point,  is  inserted  with 
but  little  sensation  and  a  current  of  5  to  20  milliamperes  turned  on 
for  ten  minutes;  a  blanching  effect  is  soon  seen  to  occur  in  the  pile, 
and  the  instrument  may  be  withdrawn  without  bleeding  from  the 
point  of  insertion  if  sufficient  current  has  been  used. 

This  puncture  will  probably  be  sufficient  for  the  one  hemor- 
rhoid;   at  any  rate,  healing  should  occur  before  repetition  in  that 


Fig.  7G. — Author's  hemorrhoidal  needle  electrode   (sectional  view,  showing 
appearance  when  coated  with  shellac). 

tumor,  but  other  tumors  should  be  sought  for  and  a  similar  cataphoric 
application  and  puncture  made  at  the  same  sitting  if  the  patient's 
endurance  of  the  posture  continues  long  enough.  If  the  needle  has 
been  insulated  in  such  a  manner  that  an  eighth  of  an  inch  of  the 
shellac  insulation  will  follow  the  point  into  the  pile,  further  insertion 
being  guarded  against  by  a  shoulder  or  bulbous  portion  of  the  insula- 
tion at  the  proper  spot,  the  after-treatment  is  very  slight,  consisting 
of  cleansing  injections  of  hamamelic  extract  or  a  weak  solution  of 
acetanilid  after  defecation  with  occasional  applications  of  an  ointment 
of  either  of  these  agents  by  means  of  a  rectal  ointment-applicator. 

Prolapse  of  the  Rectum. — Moderate  degrees  of  this  mechanical 
displacement  of  redundant  rectal  walls  may  be  successfully  treated  by 
a  combination  of  two  methods:  labile  intrarectal  applications  of  the 
positive  pole  of  a  combined  galvanic  current  of  20  milliamperes  and 
the  primary  faradic  Cthe  author's  rectal  electrode  [Fig.  67]  being 
used)  and  submucous  puncture. 


DISEASES    OF    THE    BLADDER    AND    RECTUM.  371 

The  purpose  of  the  labile  rectal  application  of  both  currents  is 
the  stimulation  of  the  muscular  walls  of  the  rectum  and  the  various 
muscular  structures  adjacent^  in  order  that  the  normal  tone  may  be 
restored.  This  is  usually  followed  by  an  immediate  retraction  of  the 
protrusion,  which  frequently  remains  in  proper  position  for  increasing 
periods  of  time  after  this  simple  application.  If  made  daily  it  may 
cure  moderate  conditions  of  prolapse  without  further  elaboration  of 
method.  In  the  absence  of  the  amalgamated-zinc  electrode,  with 
which  it  is  proper  to  employ  the  positive  pole  (the  mercury  prevent- 
ing cauterization  under  the  moderate  current  and  constant  movement 
advised),  the  negative  pole  may  be  used  with  a  rectal  olive  of  any 
metal.  The  Sims  position  is  usually  the  most  convenient  for  this 
maneuver. 

The  purpose  of  the  submucous  puncture  is  the  production  of  a 
cicatricial  adhesion  between  the  redundant  walls  and  the  underlying 
areolar  tissue.  Either  pole  may  be  used,  the  position  of  patient  and 
anesthetic  cataphoresis  being  the  same  as  described  in  the  puncture 
of  hemorrhoids.  The  needle  is  inserted  at  but  a  slight  angle  with 
the  longitudinal  axis  of  the  rectum,  and  about  20  milliamperes  used 
for  ten  minutes.  But  little  can  be  accomplished  by  puncture,  how- 
ever, as  the  adhesions  produced  in  such  a  manner  are  evanescent. 

Stricture  of  the  Rectum. — The  unsurpassed  value  of  electricity 
in  strictures  of  the  rectum  is  well  shown  in  Newman's  article  in  the 
"International  System  of  Electro-Therapeutics."  Its  special  action 
here,  as  in  other  strictures,  is  the  dilating  and  softening  effect  of  the 
negative  pole  and  the  possibility  of  causing  absorption  of  the  cica- 
tricial fibrous  structure  causing  the  stricture.  The  size  of  the  bulbs 
required  makes  it  possible,  as  well  as  necessary,  to  use  much  more 
current  than  in  the  urethra,  with  added  boldness  of  technique. 

The  instrumental  equipment,  in  addition  to  the  usual  abdominal 
pad  for  a  dispersing  pole,  consists  of  a  rectal  electrode  with  shank 
about  nine  inches  long  to  which  three  or  four  sizes  of  bulbs  may  be 
screwed,  varying  in  diameter  from  one-third  to  one  inch.  Semi- 
elastic  shanks  have  been  advised  by  some  writers  and  repeatedly  used 
by  the  author,  but  are  rarely  satisfactory  in  the  firmer  or  narrower 
strictures,  owing  to  one's  inability  to  direct  the  bulb  properly.  An 
important  improvement  applied  to  these  electrodes  by  the  author  is 
shoAvn  in  Fig.  66,  which  is  tunneled  for  attachment  to  a  syringe  in 
order  that  a  cushion  of  water  or  oil  may  be  made  to  precede  the 


272  DISEASES    OF    WOMEN. 

instrument,  dilating  the  natural  channel  up  to  the  point  of  the 
stricture.^ 

Essential  elements  of  success  in  this  work  are  a  knowledge  of 
the  anatomy  of  the  rectum  and  of  its  several  sphincters,  and  extreme 
gentleness  in  passing  the  electrode  to  the  contracted  spot,  where  but 
slight  pressure  is  demanded,  the  dilating  effect  of  the  current  of  20 
milliamperes  or  more  being  relied  upon. 

Should  the  stricture  bear  evidence  of  being  due  to  a  malignant 
growth,  the  fact  that  the  author's  electrode  bulbs  are  of  zinc  comes 
in  play,  since  when  well  amalgamated  the  polarity  of  the  instrument 
may  be  changed  to  positive  after  the  diseased  spot  has  been  reached 
and  a  stronger  application  of  mercuric  cataphoresis  made  before  it 
is  withdrawn,  as  in  the  ulcerative  conditions  described  below. 

Ulcerations  and  Adenoids  of  the  Rectum. — For  these  conditions 
the  mild  zinc-mercuric  cataphoresis  is  indicated,  with  current- 
strengths  of  30  to  50  milliamperes  applied  from  olive-shaped  zinc 
instruments.  The  results  are  most  excellent,  and  could  probably  be 
attained  in  no  other  way. 


'  The  author  does  not  claim  the  tunneled  rectal  electrode  as  a  novelty, 
except  as  applied  to  a  dilating  instrument  for  the  upper  rectum,  hollow  rectal 
electrodes  having  been  devised  by  Boudet,  King,  Cleaves,  and  others. 


CHAPTER  XXI. 

The  Cosmetic  Applications  of  Electricity. 

The  chief  cosmetic  uses  of  electricity,  in  addition  to  the  restora- 
tion of  a  normal  clearness  of  complexion  by  a  galvanic  stimulation 
of  the  liver  and  other  abdominal  organs,  is  the  destruction  of  super- 
fluous hairs  on  the  face  or  elsewhere,  the  removal  of  small  surface- 
tumors  of  the  skin,  moles,  and  warts;  of  nevi,  or  port-wine  marks; 
and  of  pigmented  nevi.  Electricity,  or,  more  particularly,  the  solvent 
action  of  the  negative  pole  of  the  galvanic  current,  is,  in  every  way, 
the  best  method  of  removing  these  blemishes,  which,  when  situated 
on  the  face  or  other  conspicuous  portion  of  the  skin,  not  only  mar 
the  appearance  of  the  person,  but  are  often  responsible  for  an  un- 
happy disposition  in  the  persons  thus  afflicted.  The  skillful  applica- 
tion of  the  proper  remedy  for  these  deformities  is  not  the  highest 
work  of  the  educated  physician,  it  is  true,  yet  it  is  by  no  means 
beneath  him,  and,  when  it  is  remembered  that  the  proper  performance 
of  the  work  demands  a  considerable  knowledge  of  the  anatomy  and 
pathology  of  the  skin,  it  is  his  duty  to  rescue  it  from  the  hands  of 
ignorant  charlatans. 

Superfluous  Hair. — The  destruction  of  superfluous  hair  is  accom- 
plished by  the  electrolytic  destruction  of  the  germinal  papilla  at  the 
bottom  of  the  hair-follicle,  and  it  may  be  said  that  there  is  no  other 
known  Avay  in  which  this  may  be  done  without  destruction  of  the 
adjacent  skin.  The  world  is  indebted  to  Dr.  W.  A.  Hardaway,  of 
St.  Louis,  Mo.,  for  the  discovery  of  this  fact,  which  has  been  further 
elaborated  by  Dr.  George  H.  Fox,  of  New  York,  and  the  late  Dr. 
Plym.  S.  Hayes,  of  Chicago.  The  pole  employed  is  invariably  nega- 
tive and  a  current-strength  of  from  -J  to  2^  milliamperes  is  sutflcient, 
according  to  the  size  of  the  hair  and  the  duration  of  the  application, 
when  it  is  concentrated  at  the  point  of  a  fine  needle  inserted  into  the 
follicle.     This  amount  of  current  may  be  obtained  from  a  variable 

"     '  (273) 


274  DISEASES    OF    WOMEN. 

nujnber  of  cells  when  a  controller  is  used,  though  it  is  thought  to  be 
more  painful  if  the  voltage  is  greater  than  that  obtained  from  about 
twenty  cells.  As  the  physician  will  be  most  apt  to  use  the  same 
apparatus  for  this  work  as  that  employed  in  ordinary  therapeutic 
applications,  it  is  only  necessary  to  cut  out  some  cells  by  a  switch- 
selector  or  otherwise  attach  that  number  of  cells  to  his  switch-board. 

The  special  instruments  required  are  a  needle  and  a  pair  of 
epilating  forceps,  the  latter  to  be  broad-pointed,  non-serrated,  and 
with  a  weak  spring. 

A  proper  needle  is  a  matter  of  extreme  importance,  since  it  is 
necessarily  very  fine  to  traverse  the  smaller  hair-follicles  which  are 
already  nearly  filled  with  the  hair  themselves,  yet  the  point  should 
be  so  blunt  as  not  to  pierce  the  sheath  of  the  follicle,  but  merely 
follow  the  hair  to  its  base.  Specially-ground  jewelers'  broaches  have 
been  generally  recommended,  of  steel,  since  the  negative  pole  is 
invariably  used,  but  I  have  preferred  one  less  easily  broken,  which  has 
been  made  from  hard,  gold  spectacle-wire.  This  is  ground  fine  and 
with  a  very  small  bulbous  point.  The  handle  should  be  light  and 
without  any  current-breaking  mechanism,  as  is  sometimes  mistakenly 
added,  the  cord  to  be  attached  being  unusually  light.  I  have  in  some 
instances  succeeded  in  insulating  the  needle  a  few  lines  above  the 
point  by  fusing  a  light  coating  of  hard  rubber  on  it.  This  will  permit 
the  electrolysis  to  be  restricted  to  the  point,  beneath  the  actual  sur- 
face of  the  skin,  and  will  lessen  pain  and  scarring. 

The  patient  is  placed  in  a  large  chair  by  many,  but  the  writer 
prefers  in  this  and  all  other  face  applications  that  she  lie  on  a  couch 
in  a  good  light  with  her  head  well  up  on  the  head-piece,  the  opera- 
tor sitting  behind  and  leaning  over  with  his  elbows  resting  on  the 
side  of  the  pillow.  The  poles  of  the  battery  are  thoroughly  identified 
and  the  positive  binding-post  connected  with  a  moist  pad  laid  on  a 
towel  in  her  lap,  on  which  the  patient  presses  her  hand  to  close  the 
circuit  and  raises  it  therefrom  to  break  it  at  command,  the  pad  becom- 
ing thus  a  delicate  controller  to  make  and  break  the  circuit  without 
suddenness. 

Everything  being  in  readiness,  the  needle,  connected  with  the 
negative  pole  with  an  appropriate  cord  or  very  fine  insulated  wire,  is 
inserted  into  the  follicle  without  piercing  its  walls,  the  patient  is 
directed  to  press  the  pad,  the  proper  amount  of  current  is  turned  on 
through  the  Massev  controller,  which  is  not  thereafter  disturbed,  and 


COSMETIC    APPLICATIONS.  •  275 

the  action  of  the  current  noted.  When  the  hair  is  loosened,  as  it 
will  be  in  a  few  seconds,  if  the  needle  has  been  properly  placed,  it 
is  removed  by  the  forceps  in  the  other  hand  of  operator;  the  patient 
is  directed  to  raise  the  hand,  when  the  needle  is  removed,  reinserted 
into  another  follicle,  and  the  process  repeated.  The  patient's  hand  is 
always  up,  therefore,  wheu  the  needle  is  either  inserted  or  removed, 
greatly  lessening  the  pain,  which  is  often  considerable.  After  the 
skin  has  been  broken  by  an  application  a  strong  solution  of  cocaine 
should  be  spread  over  the  surface,  and  though  the  polarity  of  the 
electrode  will  not  carry  much  of  it  in  by  cataphoresis  a  distinct  dull- 
ing of  sensation  will  be  soon  manifest  from  it,  doubtless  by  absorp- 
tion through  the  little  punctures  made.  If  four  hairs  are  removed 
at  the  angles  of  a  surface  a  little  over  a  half-inch  in  area  the  inclosed 
space  quickly  becomes  anesthetized,  permitting  the  hairs  within  it 
to  be  removed  at  this  sitting  without  sensation.  But  it  is  not  wise 
to  remove  hairs  closely  contiguous,  owing  to  the  tendency  of  the  little 
cauterizations  to  coalesce,  producing  too  palpable  a  scar. 

The  seance  should  not  be  prolonged  beyond  a  half-hour  at  a 
time,  in  the  interest  of  both  patient  and  operator. 

A  few  hair-papillas  will  escape  destruction  at  the  hands  of  even 
skilled  operators;  but  they  are  readily  removed  when  they  reappear. 
To  guard  against  an  undue  number  of  these,  care  should  be  observed 
not  to  remove  the  hair  until  it  is  thoroughly  loosened. 

Moles  and  Warts. — The  special  advantage  of  negative  electrol- 
ysis in  the  removal  of  both  moles  and  warts  is  that  it  enables  us,  by 
a  nice  adjustment  of  the  destructive  action  to  the  actual  tissue  to 
be  destroyed  to  devitalize  the  little  tumor  at  one  sitting  without  the 
destruction  of  the  underlying  skin  as  with  acids  or  the  knife,  the 
slight  scar  left  for  a  few  weeks  disappearing  entirely  after  a  time. 
The  details  are  practically  the  same  as  for  the  removal  of  a  hair, 
except  that  a  sharp  needle  is  used,  passed  into  the  growth  a  little 
distance  above  its  base,  and  that  about  5  milliamperes  is  usually  re- 
quired, turned  on  very  gradually.  The  current  should  be  continued 
until  the  growth  is  quite  disintegrated  in  the  case  of  moles,  but  warts 
often  disappear  after  only  a  partial  destruction  of  their  bases,  appar- 
ently by  an  influence  on  their  nutrition.  In  either  case  the  crusts 
should  be  left  undisturbed  until  they  fall  off,  to  avoid  scarring. 

Nevus  Vasculosus  (Port-wine  Mark) . — This  congenital  dilatation 
of  the  capillaries  of  the  skin  is  at  times  of  large  extent,  constituting 


276  DISEASES    OF    WOMEN. 

a  serious  disfigurement.  Its  treatment,  which  necessitates  an  occlu- 
sive inflammation  of  the  capillaries,  is  both  tedious  and  painful,  yet 
the  results  attainable  are  fully  worth  the  effort.  The  active  pole, 
negative,  to  avoid  undue  scarring,  consists  of  a  number  of  needle- 
points projecting  from  a  disk,  enabling  as  many  punctures  to  be  made 
simultaneously.  The  current  is  empirically  regulated  and  maintained 
(at  about  3  milliamperes  per  needle)  until  a  white  wheal  appears  at 
each  puncture,  when  it  is  turned  off  and  the  instrument  reapplied 
at  another  place.  The  result  of  each  healed  puncture  is  a  minute 
white  scar  at  its  site,  and  it  is  therefore  necessary  to  repeat  the  ap- 
plication a  number  of  times  at  intervals  of  a  month  in  order  that  the 
whole  surface  may  be  turned  into  a  slightly  roughened  cicatrix,  which 
is  far  more  sightly  than  the  nevus. 

The  application  is  quite  painful  and  for  a  thorough  treatment  it 
is  wise  to  employ  anesthesia,  particularly  since  the  applications  are 
necessarily  at  long  intervals.  It  is  possible  that  if  the  needles  were 
of  irido-platinum  and  the  positive  pole  used  the  greater  scarring  from 
short  applications  would  be  of  advantage,  but  the  author  is  not  aware 
that  this  has  been  tried. 

Nevus  Pigmentosus. — This  form  of  nevus,  characterized  by  the 
deposit  of  pigment  within  the  skin  and  freqviently  by  the  associated 
growth  of  superfluous  hairs,  is  treated  in  the  same  way  as  the  vascular 
nevus,  the  hairs  being  first  removed  in  the  usual  way.  The  pigment 
is,  at  times,  apparently  decomposed  by  the  electrolysis,  the  metallic 
constituents  being  deposited  on  the  negative  needle. 


PART  II. 

EUDIMENTS  OF  MEDICAL  ELECTRICITY. 


CHAPTER  XXII. 

Physics  of  the  Galvanic,  or  Dieect,  Current. 

While  our  knowledge  of  the  true  nature  of  electricity  itself  is 
yet  indefinite,  it  is  fortunate  that  its  manifestations  in  motion — the 
only  condition  in  which  it  is  of  service  to  physicians — are  as  real, 
comprehensible,  and  measurable  as  a  simple  current  of  water.  If 
there  is  mystery  attending  its  use  in  medicine  it  is  the  mystery  of 
all  remedies  applied  to  yet  imperfectly  understood  physiologic  and 
pathologic  processes. 

Certain  facts  relating  to  their  non-compressibility  have  led  recent 
investigators  to  regard  electric  currents  as  currents  of  a  real  fluid. 
Be  this  as  it  may,  the  fact  that  their  laws  in  motion  are  exactly 
analogous  to  those  of  hydraulic  currents  has  enabled  us  to  frame  a 
definite  mental  picture  of  them,  and  assists  us  greatly  in  a  compre- 
hension of  their  qualities. 

If  we  examine  a  stream  of  water  issuing  from  a  reservoir  (Fig. 
77)  we  will  find  two  qualities  which  will  not  be  difficult  to  separate 
in  the  mind:  pressure  and  volume.  The  former  is  the  force  by  which 
water  transports  itself,  due  to  gravity,  and  depends  on  the  height  of 
the  water  in  the  reservoir.  It  is  the  same  in  all  pipes  issuing  from  it, 
whether  large  or  small.  The  volume  of  water  carried  by  a  pipe,  on 
the  other  hand,  depends  on  the  size  and  length  as  well  as  on  the 
pressure. 

Electromotive  Force  (Pressure). — In  electric  currents  the  force 

(277) 


278 


DISEASES    OF    WOMEN. 


governing  the  transportation  of  the  energy  is  called  electromotive 
force,  due  to  a  kind  of  electric  gravity,  or  heaping  up  of  energy  at 
the  positive  pole.  This  force  is  likewise  independent  of  the  size  of 
the  conductors  attached  to  its  reservoir,  but  the  bulk,  or  volume,  of 
the  current  will  depend  on  the  size  and  length  of  the  conductor  as 
well  as  on  the  electromotive  pressure. 

Just  why  a  contrivance  such  as  a  galvanic  cell  should  give  rise 
to  the  pressure  leading  to  current-flow  is  not  so  clear  as  is  the  anal- 
ogous pressure-origin  in  water-currents.     It  is  easy  to  conceive  that 


Fig.  77. — Diagrammatic  representation  of  the  cause  of  flow  in  hydraulic 
currents.  The  pressure,  measured  by  a  vertical  scale  of  feet,  is  due  to 
the  elevation  of  the  source,  or  reservoir.  The  amount  of  water  delivered 
will  depend  on  the  calibre  of  the  pipe  as  well  as  on  the  height  of  this 
pressure. 


a  water-current  will  flow  downward  through  pipes  by  virtue  of  the 
actual  weight  of  the  water,  the  available  weight  being  proportional 
to  the  vertical  height  of  the  water-column.  All  that  we  know  of  the 
cell-origin  of  electric  pressure  is  that  it  is  an  inherent  quality  of  any 
two  metals  that  one  is  positive  to  another  when  both  are  plunged 
into  an  acid  or  saline  bath,  and  that  a  current  starts  from  the  sub- 
merged surface  of  the  positive  element  toward  the  submerged  por- 


PHYSICS    OF    THE    GALVANIC    CUEEENT. 


279 


tion  of  the  negative  element  and  emerges  at  the  unsubmerged  por- 
tion of  the  negative  element.  The  upper  portion  of  the  negative  ele- 
ment (Fig.  79)  is,  therefore,  the  positive  pole,  as  it  is  at  this  point 
that  an  accumulation  of  electric  energy  occurs  in  a  cell,  while  a  corre- 
sponding deficiency  is  found  at  the  upper  portion  of  the  positive  ele- 
ment, constituting  the  negative  pole.  When  the  two  poles  are  united 
by  a  conductor,  such  as  a  wire,  the  body,  etc.,  a  current  tiows  from  the 
positive  pole  to  the  negative  pole  in  response  to  nature's  effort  to 
re-establish  an  equilibrium.  It  is,  however,  the  peculiar  virtue  of  a 
good  cell  that  the  difference  of  level  is  maintained  bv  chemic  action 


Fig.  78.^ — Diagrammatic  representation  of  the  cause  of  flow  in  electric 
currents.  The  pressure  (or  electromotive  force),  measured  Dy  a  scale  of 
volts,  is  due  to  the  elevation  of  the  electric  level  of  the  positive  end  of 
th3  conductor  by  the  particular  generator  in  use.  The  amount  of  cur- 
rent delivered  will  depend  on  the  size  and  conductivity  of  the  wire  as  well 
as  on  the  height  of  this  pressure. 


between  the  liquid  and  the  elements,  resulting  in  a  constant  main- 
tenance of  the  pressure  at  the  positive  pole  and  a  continuous  current- 
effort  at  equilibrium  until  either  the  chemic  activity  of  the  liquid  is 
exhausted  or  the  positive  element  is  consumed.  We  can  ascertain  the 
direction  of  the  current  always  by  knowing  that  it  is  invariably  the 
positive  element  that  is  consumed,  on  the  surface  of  which  the  cur- 
rent begins.    By  knowing  this,  we  know  that  the  outer  portion  of  the 


280 


DISEASES    OF    WOMEN. 


opposite  plate  is  always  the  positive  pole  of  the  cell.  It  so  happens 
that  zinc  is  almost  invariably  used  as  the  perishable  element  in  a 
cell,  and  usually  carbon  the  unattacked  element;  hence  the  positive 
pole  of  such  a  cell  is  the  outer  portion  of  the  carbon,  or  a  wire  at- 
tached to  it. 

A  galvanic  cell  with  its  circuit  "open" — i.e.,  without  conducting 
material  connecting  its  poles — may  be  said  to  resemble  a  small  reser- 
voir full  of  water  with  the  outlet  closed  and  ready  to  supply  a  cur- 
rent to  a  pipe.  When  the  poles  of  the  cells  are  connected  and  a 
current  flows  it  is  like  the  same  reservoir  with  valves  open,  supplying 
a  current  of  water  to  its  pipes,  the  water-level  in  the  reservoir  being 


Jhs.  Pofe 


\    - 


Fig.  79. — Diagram  of  direction  of  current  within  a  cell. 


maintained  by  pumps  that  are  analogous  to  the  chemic  action  within 
the  cell. 

But  the  galvanic  cell  is  by  no  means  the  only  method  by  which 
electromotive  force  may  be  created.  Fig.  80  indicates  how  a  dynamo, 
electric  machine,  or  induction  apparatus  may  cause  a  pressure  by 
heaping  up  energy  at  the  positive  pole,  showing  its  analogy  to  a 
pump. 

T/ie  YoU. — The  unit  of  electromotive  force,  or  pressure,  is  the 
volt;  so  named  after  Volta.  It  has  been  derived  from  mathematic 
calculation,  based  on  fundamental  units  of  length,  mass,  and  time, — 
the  centimetre,  gramme,  and  second,  or  C.  G.  S.,  system  of  units. 


PHYSICS    OF    THE    GALVANIC    CUERENT. 


281 


The  physician,  however,  needs  but  to  remember  that  the  practical  volt 
is  almost  exactly  the  amount  of  electromotive  force  produced  by  a 
good  zinc  and  copper  cell,  known  as  the  Daniell  cell.  Two  such 
cells,  arranged  in  "series"  as  in  Fig.  78, — that  is,  with  the  zinc  of  the 
first  connected  with  the  copper  of  the  second, — will  raise  the  poten- 
tial in  the  circuit  to  two  volts.  Five  such  cells  will  give  five  volts 
and  ten  cells  ten  volts,  the  unconnected  copper  of  the  first  cell  being 
the  positive  pole  of  such  a  battery  and  the  unconnected  zinc  of  the 


\\\\\\\\\\N\\\\\\\\\\\\\\\\\\\\\\\^^ 

Fig.  80. — Diagram  showing  analogy  of  laws  governing  pressure  iu 
pump  and  dynamo  circuits. 


last  cell  the  negative  pole.  Of  the  cells  in  medical  batteries  it  may 
be  said  that  all  zinc  and  copper  cells  possess  an  electromotive  force 
of  about  one  volt,  zinc  and  silver  cells  about  the  same,  and  zinc  and 
carbon  cells  about  one  volt  and  a  half.  An  ordinary  portable  battery 
of  thirty  zinc-carbon  elements,  such  as  is  largely  employed  with  acid 
solutions,  gives,  therefore,  a  current  with  a  pressure  of  about  forty- 
five  volts  when  in  good  condition. 

Resistance. — It  was  said  above  that  the  pressure  of  an  hydraulic 


283  DISEASED    OF    WOMEN. 

current  from  a  reservoir  of  a  certain  height  was  independent  of  the 
size  of  the  pipes  through  which  it  issued,  being  the  same  whether 
the  pipe  was  large  or  small.  The  amount  of  water  passing  through 
the  pipes  will,  however,  depend  on  their  calibre  and  the  frictional 
resistance  of  the  water  against  the  sides  of  the  pipe.  The  calibre  of 
an  electric  conductor  is  equally  important  in  regulating  the  volume 
of  the  current  that  will  pass  through  it  from  a  given  pressure,  while 
a  certain  frictional  resistance  to  electric  conduction  exists  in  the 
metallic  conductor  itself  not  unlike  the  internal  friction  of  the  pipe. 

The  Ohm. — The  adopted  unit  of  resistance  is  the  ohm,  named  for 
Professor  Ohm,  of  Germany,  and  is  equal  to  the  amount  of  resistance 
presented  by  a  column  of  mercury  one  metre  high  and  one  millimetre 
thick.  A  more  convenient  idea  of  this  amount  of  resistance  is  con- 
veyed by  the  statement  that  it  is  equal  to  that  presented  by  a  wire 
of  pure  copper  two  hundred  and  fifty  feet  long  and  one-twentieth  of 
an  inch  in  diameter.  Five  hundred  feet  of  such  wire  will  give  two 
ohms  resistance,  and  one  thousand  feet  four  ohms.  On  the  other  hand, 
if  the  two  hundred  and  fifty  feet  of  copper  wire  be  twice  the  area  in 
cross-section  it  will  give  but  a  half-ohm  resistance,  and  so  on. 

The  resistance  of  a  conductor  is  therefore  directly  as  to  its  length 
and  inversely  as  to  its  cross-section. 

Specific  Besistance. — Homogeneous  conductors,  such  as  metals  or 
solutions  of  definite  proportions,  present  differing  resistances,  how- 
ever, even  in  conductors  of  the  same  size  and  length.  A  one- 
twentieth-inch  iron  wire,  two  hundred  and  fifty  feet  long,  for  in- 
stance, will  present  a  resistance  of  5.36  ohms,  because  an  iron  wire 
of  the  same  size  and  length  has  a  resistance  5.36  times  greater  than 
copper.  This  differing  facility  of  conduction  is  an  inherent  quality 
of  different  substances,  and  is  called  their  specific  resistance.  It  is 
probably  due  to  a  frictional  resistance  to  flow  presented  by  the  con- 
stituent molecules  of  the  conductor.  The  resistance  of  copper  is 
taken  as  the  unit  of  comparison,  or  1. 

Table  of  Specific  Resistances. 

Mfl'll.  Sprrifir  liefintiince. 

Silver  0.77 

Gold 1.38 

Aluminum   2.29 

Zinc    2.82 


rilYSlCS    OF    THE    GALVANIC    CURRENT.  283 

Metal.  Specific  ResiaUince. 

Iron   5.36 

Tin Q.tQ 

Platinum  7.35 

Lead     9.96 

German  silver 10.09 

Antimony    18.07 

Mercury  47.48 

Bismuth 64.53 

Graphite    1106.00 

Gas-carbon    2037.00 

The  Laiv  of  Ohm. — In  hydraulic  currents  it  has  been  said  that 
the  volume  of  the  water  circulating  in  a  pipe  will  depend  on  the 
pressure,  on  the  one  hand,  and  the  calibre  and  length  of  the  pipe  on 
the  other.  The  corresponding  relation  of  pressure  and  resistance 
to  current  in  electricity  is  known  as  Ohm's  law,  having  been  formu- 
lated by  Professor  Ohm  in  1827.  It  is  mathematically  expressed  by 
the  formula 

E  (electromotive  force) 

C  (current)  =  — ; 

E  (resistance) 

or  that  the  current  is  equal  to  the  electromotive  force  divided  by  the 
resistance. 

Units  of  Current. — The  Ampere. — The  amount,  or  volume,  of 
current  circulating  in  a  conductor  is  measured  in  amperes.  This  unit 
of  current-volume  is  fixed  as  the  amount  circulating  through  a  re- 
sistance of  one  ohm  from  a  pressure  of  one  volt.  A  Daniell  cell 
would,  therefore,  maintain  an  ampere  through  two  hundred  and  fifty 
feet  of  one-twentieth-inch  copper  wire  if  its  own  internal  resistance 
could  be  excluded. 

The  Milliampere. — For  medical  purposes  the  ampere  is  too  large 
a  unit;  hence  the  milliampere,  or  one-thousandth  of  an  ampere,  is 
used  for  this  purpose. 

The  Coulomd. — The  current  delivered  every  second  by  a  circuit 
having  a  pressure  of  one  volt  and  a  volume  of  one  ampere  is  equal  to 
a  coulomb,  the  unit  of  measure  for  current-quantity.  This  unit,  or 
its  corresponding  diminutive,  the  millicoulomb,  is  rarely  used  in  medi- 
cine, unless  electrolysis  alone  and  not  the  additional  effects  of  more 
or  less  suddenly  applied  volume  are  required.    A  record  of  the  milliam- 


284 


DISEASES    OF    WOMEN. 


peres  used  and  the  duration  of  the  application  conveys  more  informa- 
tion than  a  mere  record  of  the  millicoulombs  would. 

Internal  Resistance  of  Cells  and  Batteries. — In  a  circuit  made 
up  of  a  battery  and  external  conductors  there  are  two  kinds  of  re- 
sistance to  be  reckoned  with  in  estimating  the  whole  amount  to  be 
encountered, — viz.,  the  internal  resistance,  or  that  given  by  the  solu- 
tions and  elements  within  the  cells,  and  the  external  resistance,  or  that 
given  by  the  wires,  cords,  electrodes,  and  body.    Incandescent  currents 


Fig.  81. — Three  cells  connected  "in  series." 


may  be  said  to  have  external  resistance  only,  as  the  internal  resistance 
of  the  vast  reservoir  made  up  of  street-mains,  dynamos,  etc.,  is  too 
small  to  require  the  physician's  attention  from  this  point  of  view. 

Application  of  Ohm's  Law  to  the  Arrangement  of  Cells. — The 
various  needs  of  electricity  in  medicine  re({uire  that  currents  of  varied 
pressure  and  volume  be  used,  the  pressure  being  employed,  as  a  rule, 
merely  for  the  purpose  of  carrying  sufficient  volume  through  the 
tissues.  If  but  a  milliampere  or  so  is  required  the  pressure  need  not 
be  great,  but  if  a  largo  volume  i.«  desired  to  be  passed  through  the 


rUYSICS    OF    TIIK    GALVANIC    CUHllENT. 


285 


poorly  conducting  skin  the  pressure  must  bo  from  fifty  to  a  hundred 
volts.  A  single  Leclanche  cell  gives  a  pressure  of  about  one  and  a 
half  volts.  To  get  a  current  of  seventy-five  volts  from  a  battery  of 
such  cells  we  must  arrange  fifty  of  them  "in  series/'  as  in  Fig.  81, — 
that  is,  with  the  zinc  of  the  first  attached  to  the  carbon  of  the  second, 
and  so  on.  Such  a  current  will  have  sufficient  pressure  to  carry  the 
usual  amounts  of  milliamperes  required  in  medical  applications,  but 
it  will  not  heat  a  cautery-knife,  because  it  will  be  impossible  to  get 


Fig.  82. — Three  cells  connected  "for  surface,"  or  in  parallel  arc. 


more  current-volume  from  the  whole  battery  thus  arranged  than  can 
be  obtained  from  a  single  cell  on  short  circuit  (or  working  with  its 
poles  connected  directly  without  appreciable  external  resistance),  be- 
cause its  output  will  be  limited  by  its  own  internal  resistance.  To 
increase  the  output  in  the  latter  case  we  must  decrease  the  internal 
resistance,  which  is  done  by  either  increasing  the  size  rather  than  the 
number  of  the  cells,  or  by  arranging  the  cells  "for  surface"  or  in 
multiple  arc, — that  is,  with  all  the  carbons  connected  together  as  the 
one  positive  polo  and  all  the  zincs  connected  together  as  the  negative 


286 


DISEASES    OF    WOMEN. 


pole,  thus  making  them  one  cell  many  times  larger  than  the  original 
one  (Fig.  82).  The  internal  resistance  in  this  latter  arrangement  is 
decreased  by  broadening  the  path  of  the  current  through  the  battery 
itself.  By  a  computation  of  the  internal  resistances  of  cells  and  a 
calculation  of  the  pressure  required  to  overcome  the  external  resist- 
ance we  can  easily  tell  whether  we  need  a  few  large  cells  or  many  cells 
that  do  not  need  to  be  large. 

To  the  mathematic  mind  but  little  effort  is  required  to  com- 
prehend such  facts.  To  those  rusty  in  figures  I  commend  the  fol- 
lowing graphic  delineation  of  the  law  of  Ohm  as  applied  to  currents 
from  cell-batteries,  an  ideal  cell  with  an  electromotive  pressure  of  one 
volt  and  an  internal  resistance  of  one  ohm  being  depicted  for  conven- 
ience of  illustration: — 


•EXTERNAL.^  RESISTANCES. 
I  10  100 


1000      Ohms. 


47S        .082     .OOCO   .000892   AMPERE 


Fig.  83.- — Graphic  delineation  of  the  pressure  and  volumes  of  currents 
from  a  single  galvanic  cell  when  various  resistances  are  inserted  into  the 
external  circuit.  The  cell  shown  at  the  left  of  the  cut  has  an  electro- 
motive pressure  of  one  volt  and  an  internal  resistance  of  one  ohm.  The 
divisions  of  the  drawing  to  the  right  of  the  cell  represent  imaginary  longi- 
tudinal sections  of  the  currents  obtained  on  short-circuiting  the  cell  and 
after  successively  inserting  into  the  circuit  the  several  resistance  coils 
indicated  in  the  upper  portion  of  the  figure.  The  heavy  shading  in  the 
first  three  divisions  shows  the  exact  proportions  of  volume  to  the  eye  as 
compared  with  a  full  amp&re,  indicated  by  a  broken  line.  The  'ight  shad- 
ing shows  the  proportion  of  pressure,  which  is  uniformly  maintained 
throughout.  The  volume  in  the  last  three  spaces  is  indicated  by  the  fig- 
ures beneath,  but  is  much  too  small  to  l)e  shown  to  the  eye  on  the  scale 
adopted. 


Fig.  83  shows  to  the  eye  the  effect  made  on  the  current-volume 
from  a  single  cell  by  inserting  various  amounts  of  resistance  into  the 
external  circuit.     Tbe  cell  ha.^!  a  typical  pressure  of  one  volt  and  a 


PHYSICS    OF    THE    GALVANIC    CURRENT. 


287 


typical  iuternal  resistance  of  one  ohm.  When  its  terminals  are  joined 
by  a  short  band  of  copper,  so  thick  as  to  present  no  appreciable  re- 
sistance, the  current-volume  produced  is  one  ampere.  If,  now,  the 
short  band  of  copper  be  replaced  by  a  coil  presenting  a  resistance  of 
one-tenth  ohm,  making,  together  with  the  internal  resistance  of  the 
cell,  a  total  of  one  and  one-tenth  ohms,  the  resultant  volume  will 
be  diminished  to  nine-tenths  of  an  ampere. 

When  another  coil,  giving  a  resistance  of  a  full  ohm,  is  added. 


EXTERNAL  RESISTANCES 

i^  1        10     100     1000    Ohms 


I  Volt 


0896  .008S9 .000899  Ampere 


20  Amperes 


Fig.  84. — Graphic  delineation  of  the  pressure  and  volumes  of  currents 
from  a  battery  of  twenty  cells  arranged  "for  surface."  The  battery,  acting 
as  an  enlarged  cell,  has  an  electromotive  pressure  of  one  volt  and  an  in- 
ternal resistance  of  one-twentieth  of  an  ohm.  The  first  three  imaginary 
current-sections  show  the  proportions  of  volume  to  the  eye. 


the  total  now  being  two  and  one-tenth  ohms,  the  volume  maintained 
is  less  than  half  an  ampere.  A  corresponding  reduction  of  the  vol- 
ume occurs,  with  the  inclusion  of  each  additional  amount  of  resist- 
ance in  the  external  circuit;  and  when  the  whole  series  of  coils  is 
placed  in  circuit,  aggregating,  together  with  the  internal  resistance, 


288 


DISEASES    OF    WOMEN. 


a  total  of  one  thousand  one  hundred  and  twelve  and  one-tenth  ohms, 
the  current-volume  is  bronglit  down  to  less  than  nine-tenths  of  a 
milliampere. 

The  resistance  of  the  body  with  approved  electrodes  may  be  said 
to  be  represented  by  the  last  two  coils  of  the  figure  (from  one  hun- 


EXTERNAL  RESISTANCES 

T6  I        10        100       1000   Ohms 


|20  Volts 


94     .64     ,1525  .01768  Ampere 


Fig.  85. — Graphic  delineation  of  the  pressure  and  volumes  of  currents 
from  a  battery  of  twenty  cells  arranged  "in  series."  The  battery  has  an 
electromotive  pressure  of  twenty  volts  and  an  internal  resistance  of  twenty 
ohms.  The  heavy  shading  in  the  first  five  imaginary  current-sections 
shows  the  exact  proportion  of  volume  on  the  scale  of  the  preceding  cuts. 
The  space  allotted  to  represent  pressure  is  reduced,  for  convenience,  to 
one-half  the  scale  adopted  in  Figs.  83  and  84. 


dred  to  one  thousand  ohms),  while  that  of  the  platinum  loop  of  the 
galvano-cautery  knife  is  nearest  that  of  the  first  coil.  The  effect  of 
increasing  the  cell  to  twenty  times  its  size  (or  coupling  twenty  similar 


PHYSICS    OF    THE    GALVANIC    CUBBENT.  289 

cells  for  surface,  i.e.,  all  the  zincs  to  one  jDole  and  all  the  carbons  to 
thj  other),  is  shown  for  both  uses  in  Fig.  8-i,  demonstrating  the  value 
of  the  method  with  the  slight  external  resistance  and  its  inefficacy 
for  the  greater.  The  effect  of  an  increase  in  the  voltage  in  passing 
more  current  through  the  higher  resistances  is  shown  in  Fig.  85,  which 
also  displays  the  disadvantage  of  this  method  in  the  low  resistances, 
as  the  additional  cells  brins:  with  them  additional  internal  resistance. 


CHAPTER  XXIII. 

The  Pkoduction  and  Contkol  of  Galvanic  Cukkents. 

The  galvanic  currents  used  in  medicine  are  procured  from  bat- 
teries of  cells  arranged  to  give  sufficient  voltage  (from  10  to  150 
volts,  according  to  the  nature  of  the  medical  work)  or  from  reliable 
direct-current  incandescent  lighting-mains,  the  latter  usually  having 
a  pressure  of  110  volts.  In  either  case  the  currents  are  modified  by 
an  applying  apparatus  consisting  essentially  of  a  controller  and  meter, 
with  the  necessary  switches  and  binding-posts.  Where  reliable  Edison 
incandescent  circuits  are  available  that  are  either  under  the  absolute 
control  of  the  operator  or  placed  underground  and  kept  free  from 
danger  of  contact  with  arc-light  and  trolley-ear  wires  and  kept  con- 
stantly supplied  with  current,  there  is  no  reason  for  the  physician  to 
use  a  battery  as  a  source  of  current.  All  batteries  require  intelligent 
care  and  are  likely  to  give  more  or  less  trouble  in  replenishing  and 
repairs,  all  of  which  is  relegated  to  the  dynamo-house  in  the  case  of 
incandescent  circuits.  Yet  no  one  should  begin  the  use  of  an  in- 
candescent circuit  until  he  has  assured  himself  by  investigation  that 
his  circuit  is  free  from  the  defects  and  dangers  referred  to. 

SOURCES    OF    CURRENT. 

The  Incandescent  Circuit. — Being  assured  that  there  will  be  no 
possible  interruption  of  the  current  to  be  delivered  from  the  110- 
volt  Edison  direct-current  mains,^  its  use  in  medical  applications  is 
very  simple,  the  two  supply-wires  being  attached  to  the  apparatus, 
whether  it  be  a  cabinet  or  table  switch-board,  just  as  the  wires  lead- 
ing from  the  carbon  and  zinc  elements  of  the  battery  are  attached. 
The  polarity  of  each  wire  should  first  be  tested  as  described  on  page 


'  The  Westinghouse  system  of  incandescent  house-lighting,  so  largely  used 
in  smaller  towns,  employs  an  alternating  current  totally  unlike  those  consid- 
ered here,  and.  of  course,  lacking  in  the  properties  of  a   direct  current.     Its 
employment  in  medicine  is  referred  to  elsewhere. 
(290) 


PRODUCTION    AND    CONTROL    OF    GALVANIC    CURRENTS.  291 

312  and  labeled,  the  positive  wire  being  permanently  attached  in  the 
place  arranged  for  the  wire  from  the  carbon  pole  of  the  battery  and 
the  negative  in  that  for  the  zinc.  Two  precautions  are,  however, 
essential,  one  being  that  the  electrician  should  insert  a  fuse  between 
the  mains  and  apparatus  to  permit  not  more  than  one  ampere  of  cur- 
rent to  circulate  through  it;  and  the  other  that  no  switch  that  will 
short-circuit  the  current  be  permitted  in  the  cabinet  or  other  ap- 
paratus. These  precautions  are  to  be  observed  to  preserve  the  meter 
and  other  apparatus  from  burning  out,  and  they  are  both  important 
on  that  account,  particularly  the  rearrangement  of  switches,  since  all 


+ 
Fig.  86. — Diagram  of  circuit  arrangement  for  using  incandescent  current. 
A,  lamp-socket  with  plug  inserted;    B,  double  conductor;    C, 
controller;    D,  meter;    E,  electrode  binding-posts. 

the  older  apparatus  and  batteries  have  switches  that  short-circuit  the 
cells  every  time  they  are  turned. 

If  a  separate  meter  and  controller  are  used  instead  of  the  per- 
manent switch-board  they  should  be  connected  up  when  used,  as 
shown  in  Fig.  86,  after  testing  and  marking  the  polarity  of  the  in- 
candescent terminals.  One  wire  is  connected  directly  with  one  of  the 
binding-posts  for  the  electrodes^;  the  other  conductor  is  carried  to 
one  binding-post  of  the  controller;  from  the  other  binding-post  of 
the  controller  a  wire  is  led  to  one  binding-post  of  the  meter,  and  from 


'  It  would  be  wise  to  have  a  one-amp&re  fuse  inserted  on  this  wire. 


2\i2 


DISEASES    OF    WOMEN. 


the  other  binding-post  of  the  meter  a  wire  is  led  to  the  remaining 
electrode  bindiug-jjost.  The  electrode  binding-posts  should  now  be 
marked  with  their  respective  polarity  signs. 

In  handling  the  electrodes  and  cords  of  an  incandescent  circuit 
thus  arranged  one  must  be  careful  not  to  bring  the  metallic  parts 
of  opposite  poles  together  unless  the  controller  is  turned  off.  This 
precaution  is  merely  to  preserve  the  fuse  or  instruments  from  being 
burnt.    There  is  absolutely  no  other  danger  from  the  use  of  a  proper 


Fig.   87. — Author's  switcliboard   for  obtaining   the  galvanic   current 
from  the  Edison  incandescent  mains. 


circuit  of  the  Edison  current,  as  the  full  strength  of  this  circuit  can 
force  no  more  current  through  the  body  than  can  the  full  strength 
of  any  good  battery  of  seventy  or  eighty  cells.  To  avoid  such  acci- 
dents to  the  apparatus  the  controller  should  always  be  kept  with  the 
crank  at  the  starting-point  when  not  in  actual  use,  and  the  metallic 
parts  of  the  electrodes  and  cords  should  never  otherwise  be  brought 
together. 

When  currents  of  moderate  strength  are  to  be  used  it  is  some- 


FltODUCTlON    AND    CONTKOL    OF    GALVANIC    CUKUENTS. 


293 


times  an  advantage  to  reduce  the  pressure  of  the  Edison  current  by 
inserting  a  lamp  in  the  circuit  with  the  controller,  meter,  and  patient, 
or  the  patient  may  be  placed  in  a  shunt  circuit  at  will  as  in  Fig.  88. 


Fig.  88. — Geiger  shunt-controller,  or  volt-selector. 


To  place  the  patient  in  a  shunt  circuit  means  that  the  cur- 
rent is  split  into  two  routes,  the  one  in  which  the  patient  is  placed 
being  capable  of  such  variation  of  resistance,  in  relation  to 
the   other   circuit,    as   to    take    more    or   less    of    the    total    voltage. 


294 


DISEASES    OF    WOMEN. 


An  improved  Massey  controller,  made  on  the  shunt  principle,  specially 
adapting  it  to  the  Edison  current,  is  shown  in  Fig.  89.     This  may 


Fig.   89. — Improved   Massey   current-controller.     The   patient  is  placed 
in  a  shunt  circuit. 


*  1 

W  1 

Fig.   90. — Jewell   graphite   controller;     au  aJaplaliou  of  the  authors   con- 
roller,  so  arranged  that  the  patient  is  placed  in  "shunt  circuit." 


also  be  used  with  a  battery  of  cells.  In  both  cases  the  current  should 
be  turned  off  with  a  switch  when  not  in  use,  as  a  little  current  will 
otherwise  flow  tliroutrh   tlie  shunt.     The  ^Mcintosh   Co.  also  manu- 


PRODUCTION    AND    CONTROL    OF    GALVANIC    CURRENTS, 


295 


facture  an  excellent  shunt  current-controller  for  these  purposes  (Fig. 
90)  which  may  also  be  used  with  a  battery  of  cells. 

Stationary  Battery  of  Cells. — Where  a  battery  of  cells  is  required 
as  a  source  of  current,  and  it  is  to  be  used  in  the  office  or  hospital 
building  only,  a  stationary  battery  of  permanent  primary  cells  is  es- 
sential. Such  a  battery  consists  of  from  40  to  75  cells  arranged  in  a 
series  on  shelves  in  a  cabinet  or  convenient  closet.  By  arrangement 
"in  series"  is  meant  that  the  zinc  of  the  first  cell  should  be  connected 
by  a  wire  or  other  connector  with  the  carbon  of  the  second  cell,  the 
zinc  of  the  second  with  the  carbon  of  the  third,  and  so  on.     When 


Fig.  91. — Arrangement  of  circuit  for  Jewell  controller.  It  will  be 
noticed  that  a  current-breaking  switch  is  placed  in  the  main  circuit.  This 
should  be  off  the  button  when  not  in  use,  to  save  slight  cell-action.  The 
meter  should  be  inserted  in  the  patient's  circuit. 


all  the  cells  are  thus  connected  it  will  be  found  that  the  carbon  of 
the  first  cell  and  the  zinc  of  the  last  one  are  free.  A  wire  attached 
to  this  carbon  will  be  the  positive  pole  of  the  battery  and  another 
attached  to  the  zinc  will  be  the  negative  pole.  The  current  from  such 
a  battery  must  be  used  through  a  controller  and  meter  placed  per- 
manently and  directly  in  series,  as  described  for  the  incandescent  cur- 


296 


DISEASES    OF    WOMEN. 


rent.  These  wires,  or  ''mains/'  may  be  carried  throughout  an  insti- 
tution, terminating  in  a  pair  of  binding-costs  on  a  wall-board,  each 
binding-post  being  permanently  marked  with  the  proper  polar  sign, 
after  due  ascertainment  of  the  identity  of  the  pole.^ 

The  only  cells  worth  considering  for  this  purpose  are  the  open- 
circuit  bell-ringing  cells  easily  procured  from  first-class  hardware- 
stores  in  any  part  of  the  country-  now  that  electric  bells  are  so  com- 
mon. These  are  all  one  or  another  variety  of  the  Leclanche  cell, 
consisting  of  carbon  and  zinc  elements  in  a  saturated  solution  of 
chloride  of  ammonium.     These  cells  are  said  to  be  of  the  "open 


Fig.  92. — Mcintosh  switchboard  for  galvanic  and  faradic  currents 
derived  from  Edison  incandescent  mains. 


circuit"  variety  because  they  remain  in  good  condition  for  long 
periods  while  unused,  or  with  the  circuit  open.  If  used  on  a  circuit 
of  low  resistance  for  many  minutes  at  a  time  they  tend,  however, 
to  run  down  by  polarization,  but  will  recover  if  allowed  to  rest.  The 
variety  now  universally  used  is  a  simple  carbon  cylinder  cell,  the 
cylinder  made  in  one  piece  with  the  cap,  the  zinc  passing  through  an 


*  An  additional  pair  of  binding-posts  is  attached  to  another  circuit  in  the 
author's  sanatorium  wall-boards  for  a  current  to  operate  the  faradic  coil. 


PRODUCTION    AND    CONTROL    OF    GALVANIC    CURRENTS.  297 

insulated  opening  in  the  latter.  In  setting  up  these  cells  care  should 
be  observed  not  to  permit  the  solution  to  wet  the  upper  edge  of  the 
jars,  as  this  would  favor  capillary  "creeping"  of  the  salts.  The  zincs 
should  be  cleaned  at  least  once  in  six  months,  and  if  renewed  at  the 
end  of  a  year  or  eighteen  months  will  postpone  a  thorough  overhaul- 
ing for  a  much  longer  time  when  the  battery  receives  but  moderate 
use. 

Portable    Batteries.— Portable    galvanic    batteries    are,    at    best, 
troublesome,  yet  indispensable  when  the  patient  must  be  treated  in 


Fig.  93. — Carbon  cylinder  cell.     This  form  of  cell  has  practically 
superseded  all  other  forms  of  Leclanche  cells. 


her  own  home.  An  efficient  source  of  electricity  for  use  in  gyne- 
cology is,  however,  only  relatively  portable,  for  they  are  much  too 
heavy  to  be  carried  from  house  to  house  in  a  carriage,  the  most  that 
can  be  done  being  to  leave  one  with  each  patient,^  for  ease  of  porta- 
bility is  apt  to  be  secured  at  a  sacrifice  of  efficiency.  Much  attention 
has  been  directed,  of  late,  to  portable  batteries  consisting  of  chloride- 


^  In  large  cities  a  thirty-cell  acid  battery  may  be  hired  and   recharged 
monthly  at  a  moderate  cost. 


298 


DISEASES    OF    WOilEX. 


of-silver  cells.  Such  batteries  are  a  distinct  luxury,  as  they  may  be 
carried  in  the  carriage  or  hand  with  the  utmost  ease  and  are  ex- 
tremely convenient  for  a  Journey  or  visit  in  consultation,  but  one 
must  not  feel  certain  that  they  will  do  more  than  furnish  a  testing 
current  for  neurologic  examinations  or  slight  treatment.  They  are 
unfit  for  the  heavy  work  of  gynecology  or  general  galvanic  applica- 
tions, and  if  found  to  be  accidentally  out  of  order  are  incapable  of 


Fig.  94. — Elements  of  carbon  cylinder  cell. 


repair  by  the  user.  The  most  reliable  portable  battery  must  still  be 
the  inconveniently-portable  sulphochromate-acid  batteries  that  are  so 
liable  to  splash  acid  over  carpet  and  carriage  unless  carefully  handled, 
and  that  are  sure  to  get  out  of  order  if  not  constantly  used,  for  these 
batteries  can  be  readily  put  in  order  by  any  electrician  at  slight  ex- 
pense, and  no  one  should  practice  electro-therapeutics  who  cannot 
keep  them  in  order  himself  if  necessary.  A  thirty-cell  battery  of  this 
kind  can  be  depended  on  to  furnish  from  fifty  to  seventy-five  milliam- 
peres  for  a  daily  application  for  two  weeks  with  one  charge  of  solu- 


PKUDUCTlOiN    AM)    COX'I'ltOL    OF    GALVANIC    CURRENTS. 


399 


tion,  at  the  expiration  of  which  time  a  change  of  solution  will  make 
it  as  good  as  new  again.  The  chloride-of-silver  dry-cell  battery  would 
be  quite  unequal  to  such  a  pro^jer  requirement.  Some  of  the  portable 
dry-cell  batteries  of  other  makes  which  at  first  sight  would  seem  to 
be  useful,  owing  to  the  relatively  large  size  of  the  elements,  claim  an 
efficiency  limit  of  but  15  milliamperes. 

The  original  cell  of  the  type  used  in  the  acid  batteries  is  known 


Fig.  95. — Flemming  i^ortable  galvanic  battery  with  meter  and 
controller  attached. 


as  the  Grenet  cell,  and  consists  of  carbon  and  zinc  elements  immersed 
in  a  solution  of  bichromate  of  sodium  and  dilute  sulphuric  acid, — the 
electropoion  solution.  The  internal  resistance  of  this  cell  is  very 
small  and  the  chemic  action  intense;  hence  a  large  current-output 
results  in  the  short  periods  of  time  in  which  it  is  proper  to  use  it 
continuously.  The  essential  feature  of  the  cell  is  the  provision  for 
raising  the  zinc,  or,  in  the  complete  batteries,  both  elements,  out  of 
the  acid  when  not  in  use:   a  precaution  that  is  necessary  if  we  would 


300 


DISEASES    OF    WOMEN. 


save  the  zincs  from  being  consumed  by  "local  action,"  or  irregular 
electric  action  between  the  particles  of  pure  zinc  and  the  metallic 
impurities  found  in  the  commercial  article.  This  local"  action  is 
greatly  minimized  when  the  battery  is  in  use  and  waste  of  material 
saved  by  coating  the  zinc  with  mercury,  or  "amalgamating'^  it.  The 
mercury  unites  with  the  zinc  with  greater  ease  than  with  its  impuri- 
ties; hence  a  surface  of  pure  zinc  in  mercurial  solution  coats  this 
element,  the  mercurial  coating  remaining  until  the  zinc  is  consumed. 
For  gynecic   purposes    the    acid    battery    should    possess    either 


Fig.  90. — Insertion  of  meter  and  controller  in  circuit  of  ordinary  port- 
able galvanic  battery.  The  cord  from  the  first  carbon  is  carried  to  meter 
and  controller;     that   from   the   last  zinc  directly   to   patient. 


twenty-four  or  thirty  cells,  giving  a  pressure  of  forty  to  fifty-five 
volts  in  accordance  with  the  condition  of  the  liquid,  excellent  exam- 
ples being  procurable  from  a  numl)er  of  manufacturers  in  this  coun- 
try, notably  Flemming,  of  Philadelphia;  Waite  &  Bartlett,  Jerome 
Kidder,  and  Van  Houten  &  Ten  Broeck,  of  New  York;  and  the 
Mcintosh  Co.,  of  Chicago.     There  is  but  little  choice  between  these 


I'HUDUCTION    AND    CONTROL    OF    GALVANIC    CURRENTS.  301 

instruments,  for  none  are  usually  supplied  with  controllers.  In  such 
case  a  meter  and  controller  should  be  inserted  into  circuit  when  in 
use  (Fig.  96),  the  terminals  of  the  battery  being  treated  exactly  as 
the  incandescent  terminals  described  above. 

This  omission  has  recently  been  supplied  by  Otto  Flemming  in 
the  battery  shrown  in  Fig.  95,  which  represents  a  portable  acid 
battery  of  twenty-four  cells  with  controller  and  meter  attached,  thus 
embodying  an  instrument  of  great  utility  and  convenience  and  but 
moderate  weight,  owing^  to  the  cells  beino;  constructed  of  hard  rubber. 


Fig.  97. — Mcintosh  twenty-four-cell  portable  galvanic  battery.  This 
battery  is  one  of  the  simplest  and  most  convenient  of  its  kind.  The 
elements,  in  sets  of  six,  are  immersed  by  simply  lifting  the  section  from 
the  drip-cup  and  lowering  it  into  the  cells  at  its  side,  the  connector  being 
then  lowered  until  it  engages  in  a  cleft  in  the  next  contiguous  set.  All 
danger  of  accidental  interruption  of  the  current,  as  when  the  cells  them- 
selves are  movable,  is  thus  obviated.  The  box  is  set  into  the  lid  in  such 
a  manner  as  to  prevent  the  latter  being  closed  unless  the  elements  are  put 
back  into  their  drip-cups,  thus  conserving  the  zincs. 

The  special  value  and  convenience  of  -the  recently-devised  trans- 
portable battery  of  the  author  (Fig.  65)  is  by  no  means  limited  to 
the  treatment  of  cancer.     The  larsre  size  of  its  cells  and  the  other 


302 


DISEASES    OF    WOMEN. 


mechanical  improvements  render  it  of  unusual  value  in  all  gynecic 
work. 

Care   and  Maintenance   of   Portable   Galvanic    Batteries. — -When 


Fig.  98.— The  Kidder  portable  galvanic  battery,  showing  top  plate  and    " 
elements.     The  cells  are  raised  in  place  when  in  use. 


laid  aside  for  any  considerable  time  the  cells  of  these  batteries  are 
best  emptied  and  kept  outside  the  case,  or  the  case  itself  kept  open. 
When  about  to  be  used  the  zincs  sliould  nil  bo  carefully  amalgamated 


PKODUCTION  AND  CONTROL  OF  GALVANIC  CURRENTS.     303 

with  mercury,  which  is  best  done  by  dipping  them  into  an  amalgamat- 
ing solution,  or,  in  its  absence,  in  battery-Iluid,  after  which  the  mer- 
cury should  be  rubbed  into  their  surfaces  until  they  are  thickly 
coated  with  this  metal.  Previous  soaking  of  the  elements  in  hot  water 
will  help  to  clean  the  zincs  and  will  be  useful  in  cleansing  the  pores 
of  the  carbons.  Unless  the  carbons  are  clean  and  the  zincs  brightly 
amalgamated  the  battery-action  will  be  very  unsatisfactory  and  the 
zincs  irregularly  and  uselessly  consumed. 

The  fluid,  or  electropoion  solution,  used  in  these  batteries  should 
be  made  of  bichromate  of  sodium  and  not  of  the  potassic  salt,  as  the 
latter  is  liable  to  split  both  the  carbons  and  the  cells  by  a  heavy 
deposit  of  chrome-alum  crystals.  An  excellent  formula  is:  1  pound 
of  bichromate  of  sodium,  1  ounce  of  bisulphate  of  mercury,  to  1  gallon 
of  water;  mix  in  earthenware  vessel  and  set  aside  to  cool  before  using. 
The  bisulphate  of  mercury  will  tend  to  maintain  the  amalgamation  of 
the  zincs. 

The  cells  should  be  lowered  away  from  the  elements  immediately 
after  the  termination  of  the  application. 

APPLYING-MECHANISM. 

The  essentials  for  applying  a  galvanic  current,  whether  derived 
from  a  portable  or  stationary  battery  of  cells  or  from  an  incandes- 
cent circuit,  are  a  controller  and  meter  and  the  necessary  eonducting- 
cords  and  electrodes,  together  with  certain  switches  and  binding-posts 
for  greater  convenience.  These  are  usually  assembled  on  a  switch- 
board or  cabinet,  but  may  be  used  by  simply  connecting  the  separate 
parts  together,  as  shown  in  Fig.  86. 

The  Current-eontroller. — The  purpose  of  this  instrument  is  the 
regulation  of  a  current  to  suit  the  case  under  treatment,  permitting 
the  desired  number  of  milliamperes  to  be  turned  on  without  shock 
after  the  electrodes  have  been  placed  in  position,  and  similarly  turned 
off  at  the  termination  of  the  application.  The  author's  graphite  con- 
troller was  first  designed  and  termed  a  "current-controller"  in  1887, 
since  which  time  the  aptness  of  the  designation  has  caused  it  to  be 
applied  to  the  governors  of  trolley-cars  and  other  industrial  users  of 
current  of  various  kinds.  Until  it  was  improved  by  the  adoption  of 
the  shunt  principle  it  was  the  most  convenient  and  only  practical  in- 
strument for  the  direct  control  of  currents  from  a  fraction  of  a  mil- 


304 


DISEASES    OF    WOMEN. 


liampere  to  three  hundred  milliamperes  without  waste  of  current,  and 
should  be  used  for  the  regulation  of  all  ordinary  medical  galvanic 
currents,  no  matter  what  their  source.  It  also  controls  the  faradic 
and  sinusoidal  currents  with  equal  facilit}',  and  where  combination 
batteries  or  cabinets  are  used  all  currents  should  be  made  to  traverse 
it  before  reaching  the  patient  in  order  that  all  risk  of  shock  may  be 
eliminated. 

In  principle  of  action  this  controller  (Fig.  100)  depends  on  the 


Fig.  99. — Skeleton  drawing  of  Waite  &  Bartlett  thirty-cell  galvanic  battery. 


interpolation  into  the  circuit  of  the  variable  resistance  of  a  tapering 
area  of  graphite  rubbed  on  a  ground  porcelain  surface  from  an  ordi- 
nary lead-pencil,  the  base  of  the  area  being  nickel-plated  and  con- 
nected permanently  with  the  metallic  circuit.  Over  this  area  a 
radially-pivoted  contact  moves,  the  pivoted  end  being  also  perma- 
nently connected  with  the  metallic  circuit.  When  this  spring  touches 
the  point  of  the  area  a  slight  current  flow.c  from   metal   to  metal 


PRODUCTION    AND    CONTROL    OF    GALVANIC    CURRENTS. 


305 


through  the  poorly-conducting  graphite  layer,  the  current  increasing 
gradually  as  the  area  included  between  the  two  metals  becomes  less, 
until  finally,  when  the  spring  passes  on  to  the  nickel-plated  base,  all 
the  current  the  battery  is  caj)able  of  is  turned  on,  or,  at  any  rate,  all 
resistance  of  the  controller  is  cut  out.  The  instrument  is  not  designed 
to  measure  the  current,  but  merely  to  govern  it,  the  milliampere- 
meter,  which  should  be  invariably  in  the  same  circuit,  indicating  the 
number  of  milliamperes  actually  passing  through  the  apparatus  and 
patient  at  any  moment.     The  point  of  the  area  is  often  too  thickly 


Fig.  100.— Massey  current-controller.     In  this  original  form  the  patient  is 
in  direct  series  with   the  main- line   of  current. 


coated  with  pencil-mark  when  the  instrument  is  new,  and  should 
be  slightly  rubbed  off,  and  the  material  should  be  kept  particularly 
heavy  at  its  junction  with  the  nickel  to  avoid  a  slight  jump  in  the 
current  when  it  is  desirable  to  turn  the  full  force  of  the  battery  on. 
After  a  time  the  graphite  becomes  worn  in  places,  requiring  renewal 
by  merely  rubbing  a  soft  pencil  over  it,  preferably  the  BBB  Faber 
pencil. 

There  are  two  conditions  in  which  the  improved  Massey  con- 
troller (Fig.  89)  is  superior  to  the  older  form,  and  that  is  when  we 


306  DISEASES    OF    WOMEN. 

wish  to  give  a  weak  current  from  a  large  number  of  cells,  or  a  very 
strong  current  from  either  cells  or  incandescent  mains;  in  both  of 
these  instances  the  shunt  principle  gives  a  gradation  with  least  dis- 
comfort. 

The  current-controller  has  entirely  superseded  various  clumsy  and 
shock-producing  devices  known  as  current-selectors,  which,  except 
when  employed  as  a  two-  or  three-  point  switch  in  conjunction  with 
the  controller  for  occasional  use  of  a  less  number  of  cells  than  the 
whole,  or  in  controlling  the  very  heavy  currents  of  cancer,  are  now 
obsolete  and  deserving  of  special  description  only  in  works  devoted  to 
the  history  of  electro-therapeutics.  Water-rheostats  are  almost  equally 
objectionable,  being  clumsy,  unstable,  incapable  of  sufficiently  quick 
movement  for  many  applications,  and  always  leaving  a  small  amount 
of  resistance  in  the  circuit.  The  use  of  the  controller  with  the  in- 
candescent current  has  already  been  referred  to  (page  291). 

The  Meter. — This  instrument  is  also  indispensable  to  the  phy- 
sician, who  has  no  more  right  to  subject  a  patient  to  the  influence  of 
an  unmeasured  current  of  electricity  than  has  a  pharmacist  to  fill  a 
prescription  with  unweighed  or  unmeasured  drugs.  The  number  of 
cells  employed  is  incapable  of  giving  definite  knowledge,  owing  to 
the  varied  resistance  of  the  skin  in  different  individuals. 

Without  entering  into  details  as  to  the  construction  of  these  in- 
struments, for  which  the  reader  is  referred  to  rudimentary  treatises, 
it  is  sufficient  to  say  that  until  the  construction  of  the  Weston 
ammeter  in  1889  the  industrial  users  of  electricity  as  well  as  phy- 
sicians were  dependent  on  meters  constructed  on  the  principle  of  the 
deflection  of  a  compass  needle  by  a  current.  These  are  all  liable  to 
alteration  and  deterioration,  seriously  affecting  their  value  after  vari- 
ous periods  of  use,  and  are,  moreover,  affected  by  neighboring  masses 
of  iron  or  steel.  The  Weston  meter  is  constructed  on  a  different 
principle,  the  mutual  induction  of  coils,  and  is  now  accepted  both  at 
home  and  abroad  as  a  standard  of  correct  measurement.  Through 
the  suggestion  of  Dr.  Wellington  Adams,  who  has  produced  a  most 
valuable  treatise  on  the  physics  of  electrotherapy,  the  Weston  com- 
pany has  placed  a  medical  milliammeter  on  the  market  (Fig.  101) 
which  leaves  nothing  to  be  desired.  It  has  two  scales,  the  upper 
reading  from  0  to  500  milliamperes  and  the  lower  from  0  to  10 
in  tenths,  the  scales  being  unusually  large  and  readable.  Tt  is  also 
so  constructed  tbat  the  lower,  or  rod,  scale  mav  be  used  as  a  volt- 


PEODUCTION    AND    CONTROL    Or    GALYAXIC    CUKKEXTS.  307 

meter  for  the  measurement  of  an  electromotive  force  below  one 
hundred  volts  when  it  is  in  circuit  with  the  resistances  contained  in 
a  small  box  accompanying  it.  To  measure  the  voltage  of  a  battery 
or  cell  below  ten  volts  the  zero-marked  binding-post  of  the  resistance- 
box  is  connected  with  one  binding-screw  on  the  instrument  and 
another  wire  is  carried  from  the  cells  to  be  measured  to  the  resistance- 
box  post,  marked  1000;  the  reading  of  the  lower  scale  will  then  indi- 
cate the  volts  and  tenths  of  volts  when  the  circuit  has  been  properly 
closed  from  the  opposite  pole  of  the  tested  cells  to  the  meter.  To 
measure  the  voltage  of  a  whole  battery  (of  one  hundred  volts  or  less) 
the  same  connections  are  made,  except  that  the  wire  is  changed  to 
the    binding-screw    of    resistance-box    marked    10,000    ohms,    these 


Fig.  101. — Weston  milliammeter,  arranged  specially  for  medical  work. 
There  are  t-RO  scales.,  the  upper  measuring  to  500  milliamperes  in  divisions 
of  5  milliamperes,  for  which  the  negative  wire  should  be  attached  to 
the  binding-post  marked  500 ;  and  the  lower  scale,  measuring  to  10  milliam- 
peres in  divisions  of  '/to  .  for  which  the  negative  wire  should  be  placed  in 
binding-post  marked  10.  The  positive  wire  is  always  placed  in  post  with 
plus-mark. 

readings  being  also  on  the  lower,  or  red,  scale  and  each  division 
normally  representing  the  tenth  of  a  milliampere  now  reading  a  volt. 
The  binding-post  on  the  meter  marked  with  a  -i-  sign  should  be  con- 
nected with  the  carbon  wire  of  the  tested  battery  as  in  the  ordinary 
use  of  the  instrument  as  a  milliammeter.  The  convenience  of  having 
an  instrument  capable  of  testing  the  voltage  of  cells  and  batteries  that 
may  be  imperfect  or  needing  repair,  without  extra  cost,  will  be  greatly 
appreciated  by  physicians. 


308 


DISEASES    OF    WOMEN. 


The  value  of  this  type  of  meter  has  been  so  uniformly  demon- 
strated by  the  exhaustive  tests  annually  conducted  by  the  Committee 
on  Meters  of  the  American  Electro-Therapeutic  Association  that  a 
number  of  manufacturers,  notably  the  Edison  Manufacturing  Co., 
Otto  Flemming,  and  the  Mcintosh  Co.,  have  constructed  meters  on  a 
similar  principle. 

All  meters  of  this  type  have  one  binding-screw  marked  for  the 
positive  pole  and  are,  therefore,  not  adapted  for  a  reversal  of  the  cur- 
rent through  their  mechanism.  The  commutator,  or  pole-changer,  of 
a  switch-board  should,  therefore,  be  intercalated  in  the  circuit  be- 
tween the  meter  and  the  patient,  rendering  reversal  easy,  without  dis- 
turbing the  course  of  the  current  through  the  meter. 


Fig.  102. — Jacketed  pan  for  clay  pads.     Hot  water  is  poured  into 
the  interior  through  the  pipe  shown. 


Electrodes. — Electrodes  for  percutaneous  and  permucous  appli- 
cations of  galvanic  currents  consist  of  an  active  and  a  dispersing 
electrode  or  pole,  under  the  modern  practice  of  considering  the 
polarity  rather  than  the  direction  of  the  current.  The  active  elec- 
trodes vary  in  nature  and  form  for  each  special  application  and  are, 
therefore,  fully  described  in  the  portion  of  this  work  relating  to 
special  affections  and  particular  procedures. 

The  purpose  of  an  application  being  usually  the  concentration 
of  the  current  in  or  through  a  certain  organ  or  set  of  organs  with 
as  little  unpleasant  sensations  or  actions  elsewhere  as  possible,  the 
role  of  the  indifferent  electrode  is  not  only  the  mere  completion  of 


PRODUCTION    AaSD    CONTROL    OF    GALVANIC    CURRENTS. 


309 


the  circuit,  but  it  should  render  the  current-effect  at  this  point  as 
inactive  as  possible.  This  is  done  by  increasing  the  surface  of  con- 
tact and  by  making  the  moist  conducting-joint  (page  31)  between 
the  metal  and  the  subdermic  tissues  as  perfect  as  possible.  It  was 
the  application  of  this  principle  in  the  construction  of  the  abdominal 
clay  pad  by  Apostoli  that  gave  the  present  impetus  to  the  use  of 
strong  currents  in  gynecology,  as  already  noted. 

The  Apostoli  Clay  Pad. — The  clay  for  this  purpose  should  be 


Fig.  103. — Author's  wired  cotton  electrode  pads.     1,  abdominal  pad,  for 
general  use.     2,  spinal  pad.     3,  large  dispersing  pad. 


of  the  variety  used  by  potters,  and  should  be  kept  in  the  consistence 
of  soft  mud  by  admixture  with  water  in  a  covered  crock.  The  pad 
should  be  made  freshly  for  each  application,  or  each  morning  when 
used  daily,  and  is  most  comfortable  to  the  patient  when  heated  in  a 
Jacketed  pan  (Fig.  102)  in  the  space  between  the  double  bottom  and 
sides  of  which  boiling  water  has  been  poured.  Before  putting  the 
clay  into  the  pan  tAvo  layers  of  mosquito  netting  or  a  single  layer  of 
tarlatan  should  be  spread  out  over  the  bottom,  the  material  being 


310 


DISEASES    OF    WOMEN. 


large  enough  to  reach  beyond  the  edge  of  the  pan  to  enable  the  clay 
to  be  lifted  out  after  the  pad  is  made  by  grasping  its  ends.  The  pad 
should  be  about  an  inch  thick  and  of  a  sufficient  size  to  cover  the 
abdomen  of  the  patient.  After  lowering  it  on  the  abdominal  surface 
a  block-tin  or  lead  plate  supplied  with  a  binding-post  or  socket  for 
attachment  of  the  cord  is  pressed  down  upon  it.  This  plate  is  best 
shaped  like  a  four-leaved  clover  and  should  be  nearly  as  large  as  the 
pad. 

Eeady-made  clay  pads  arc  poor  affairs  compared  with  a  pad  so 


Fig.   104. — Author's  complete  switcliboard  arrangement  for  both  currents. 


made  and  less  useful  than  the  cotton  pads  next  to  be  described,  which 
have  displaced  all  forms  of  clay  pads  in  the  great  majority  of  the 
author's  applications. 

The  Author's  Wired-Cotton  Pads. — The  most  convenient  pads  for 
a  dispersing  electrode  to  be  used  on  any  part  of  the  body  are  the 
author's  wired-cotton  pads  (Fig.  103),  which  are  made  in  two  or  more 
sizes  as  follows:  In  the  centre  of  a  piece  of  muslin  somewhat  larger 
than  the  intended  pad  the  end  of  a  spool  of  No.  20  soft,  brass  wire 
is  sewn.     The  wire  is  then  coiled  in  an  increasing  spiral  and  securely 


PliODUCTlOA'    AJND    CONTKOL    OF    GALVANIC    CUKRENTS.  311 

sewn  in  place  on  the  muslin,  each  spiral  being  about  half  an  inch 
from  the  preceding  one,  until  the  desired  size  is  obtained,  the  shape- 
being  oval  for  the  large  pad  and  round  for  the  smaller.  When  it  ha& 
attained  dimensions  of  about  7x11  inches  for  the  larger  and  G  inches 
for  the  smaller,  a  small  turn  is  made  in  the  wire  and  sewn  down  to 
prevent  pulling  out,  and  a  considerable  length  of  wire  is  left  for  con- 
nection with  the  battery.  This  free  end  should  be  at  one  end  of 
the  spiral  for  the  large  pad  and  in  the  centre  of  the  small  one.  Six 
or  eight  layers  of  absorbent  cotton  should  now  be  cut  to  shape  and 
piled  on  the  wired  side,  and  on  top  of  the  cotton  a  piece  of  muslin 
is  placed  to  be  folded  over  and  sewn  to  the  edge  of  the  back  of  the 
pad.  The  pad  should  now  be  quilted  lightly  through  and  through  to 
keep  the  cotton  from  packing,  and  when  the  end  of  the  wire  left  free 
is  made  into  a  spiral  friction-socket  for  connection  with  a  battery-tip 
by  winding  it  about  the  end  of  the  tip,  the  electrode  is  complete. 

Such  pads  are  easily  made  by  an  intelligent  nurse.  They  are 
wet  with  hot  water  and  freely  soaped  with  ivory  soap  on  the  csntact- 
surface  farthest  from  the  wire  when  used.  Before  each  subsequent 
use  with  a  new  patient  they  should  be  boiled  for  a  few  minutes. 

The  smaller  one  of  these  pads  is  most  conveniently  used  as  an 
active  electrode  in  general  applications  (page  53)  or  as  an  indif- 
ferent pad  for  small  currents. 

Office  Switdi-boards. — Fig.  104  illustrates  an  exceedingly  con- 
venient and  complete  switch-board  for  office  use  or  an  institution 
that  is  wired  from  a  permanent  battery  of  cells.  It  may  be  attached 
to  a  portable  table  with  a  cable-conductor  of  four  wires  for  connection 
with  wall-boards  in  each  room.  Current  for  galvanic  treatment  and 
for  operating  the  faradic  coil  is  thus  conveniently  obtained  in  any 
part  of  the  house  from  powerful  and  reliable  stationary  batteries  of 
cells  in  a  cell-closet.  The  current  from  the  galvanic  battery  is  thus 
easily  controlled  at  the  bedside.  To  operate  the  faradic  coil  at  such 
a  distance  requires  about  six  chloride-of-ammonium  cells  arranged 
two  abreast  in  a  series  of  three,  and  the  Avire  should  be  of  moderately 
larse  size. 


CHAPTEK  XXIV. 

Experimental  Handling  of  Galvanic  Currents. 

No  ONE  should  apply  an  electric  current  to  a  patient  without 
having  previously  familiarized  himself  somewhat  with  its  practical 
management;  and  it  is  best  for  the  beginner  to  emphasize  the  lessons 
thus  gained  by  a  moderate  demonstration  of  the  sensory  effects  on 
his  person.  "With  the  battery  set  up  or  put  in  operation,  the  meter 
and  controller  being  in  circuit,  the  small  electrode  discs  and  cords 
may  be  attached  to  the  binding-posts  for  the  following  experiments: 

To  Test  for  Current.  (Experiment  2). — Set  the  controller  for 
least  current  (in  the  graphite  controller  with  the  crank  on  the  be- 
gining  of  the  pencil-mark  to  the  right  of  the  rubber  bridge),  and 
bring  the  brass  parts  of  the  electrodes  together.  The  meter  will  show 
a  deflection  of  more  or  less  milliamperes.  If  there  is  no  deflection 
a  break  exists  in  some  part  of  the  circuit. 

To  Test  the  Power  of  the  Battery  and  the  Range  of  the  Con- 
troller. (Experiment  3). — Unite  the  poles  directly  by  means  of  a 
conducting-cord  or  wire,  and  note  the  gradual  increase  in  the  cur- 
rent as  the  crank  is  moved  toward  the  broader  graphite.  This  pro- 
cedure is  wasteful  of  battery  power,  but  will  show  the  total  capacity 
of  the  battery  through  these  resistances,  if  the  meter  registers  high 
enough.  With  the  incandescent  current  the  increase  should  not  be 
above  the  capacity  of  the  meter. 

To  Test  the  Polarity  of  the  Electrodes.  (Experiment  4). — If 
in  doubt  as  to  which  is  the  negative  pole  and  which  the  positive  pole 
of  a  galvanic  battery  or  pair  of  incandescent  terminals,  place  the  tips 
of  the  cords  in  a  solution  of  potassium  iodide.  The  compound  will 
be  electrolyzed,  iodine  appearing  at  the  positive  pole  as  a  brownish 
cloud,  and  potassium  at  the  negative  pole.  If  the  potassium  iodide 
be  dissolved  in  starch-water,  the  discoloration  at  the  positive  pole  is 
blue  instead  of  brown,  the  nascent  iodine  immediately  uniting  with 
the  starch.  A  more  quickly  performed  test  than  this  is  to  ascertain 
which  tip  gives  off  the  greatest  amount  of  gas  when  immersed  in 
(312) 


EXPEKIMENTAL    HANDLING    0¥    GALVANIC    CURRENTS.  313 

simple  or  saline  water,  the  negative  possessing  this  distinction  on 
account  of  the  hydrogen-gas  given  off  at  its  surface  being  double  the 
volume  of  oxygen  at  the  positive.  The  negative  pole  also  gives  the 
most  sensation  when  suddenly  brought  in  contact  with  a  sensitive  part 
of  the  hand. 

Comparison  of  Metallic  Contact  with  Moist  Cotton  to  Cotton 
Conduction.  (Experiment  5). — Having  set  the  controller  for  a  weak 
current,  note  the  number  of  milliamperes  in  circuit  when  the  brass 
surfaces  of  the  two  electrodes  are  brought  together,  and  the  number 
when  the  two  wet  surfaces  of  cotton  or  sponge  are  pressed  together. 

This  will  show  the  immensely  greater  conductivity  of  brass.  As 
the  current  is  not  intended  to  go  right  back  to  the  battery  in  this 
manner  during  ordinary  work,  it  is  called  "short  circuiting,"  and  is 
wasteful  of  the  battery  power  and  dangerous  to  the  delicacy  of  the 
meter. 

Application  of  Dry  Metallic  Electrodes  to  Skin  Compared  with 
that  of  Wet  Electrodes.  (Experiment  6). — Experiment  now  with 
the  dry  metallic  surfaces  of  the  little  electrodes  pressed  down  upon 
dry  skin  surfaces.  Little  or  no  current  will  be  shown  by  the  meter 
if  the  skin  is  free  from  moisture,  even  with  the  controller  set  for  full 
strength.  Substitute  wet  cotton-covered  electrodes  for  the  dry  ones, 
and  a  current  will  be  shown  both  by  the  sensations  and  the  meter. 

The  current  passes  with  exceeding  ease  from  metal  to  metal  when 
in  contact,  either  dry  or  wet;  but  passes  from  dry  metal  to  the  body 
with  difficulty.  This  is  because  the  cuticle  is  practically  a  non-con- 
ductor; not  until  the  air-spaces  of  its  horny  layers  are  filled  with 
water,  which  is  a  reasonably  good  conductor,  will  it  permit  the  current 
to  penetrate  to  the  moister  tissues  below,  and  even  then  the  bulk  of 
the  current  passes  through  the  sweat-ducts  and  any  congested  or 
abraded  spots.  Electrode  coverings  are  therefore  designed  merely  to 
hold  a  layer  of  water  between  the  metallic  surface  and  the  skin,  act- 
ing as  a  conducting-joint. 

In  making  the  experiment  just  detailed  with  dry  metallic  points 
instead  of  a  flat  surface,  an  intense  burning  sensation  will  soon  de- 
velop if  the  full  number  of  cells  are  used  and  the  points  well  pressed 
down.  This  burning  coincides  with  the  appearance  of  some  current 
in  the  circuit,  as  shown  by  the  meter;  but  the  number  of  milliam- 
peres by  no  means  corresponds  with  the  intensity  of  the  burning; 
very  little  current  passes,  in  fact,  when  the  pain  is  greatest.     This 


314  DISEASES    OF    WOMEIS'. 

pain  of  the  '"galvanic  brush"  is  usually  described  as  due  to  the  con- 
centrated action  of  the  minute  current-quantities  upon  the  most  su- 
perficial and  sensitive  nerve-filaments;  but  doubtless  the  real  reason  is 
the  microscopic  spark  leaps  through  the  cuticle  incident  to  this  mode 
of  current-transmission. 

Effect  Produced  on  the  Current-volume  by  Salt  Water  on  the 
Electrodes.  (Experiment  7). — Set  the  controller  at  a  given  place 
and  leave  it  there  (or  use  the  full  strength  of  a  certain  number  of 
cells),  and  note  the  number  of  milliamperes  passing  through  the  hand 
when  both  wet  electrodes  are  pressed  upon  opposite  sides;  leaving 
the  battery-strength  undisturbed,  remove  the  electrodes  and  saturate 
them  with  salt  water.  When  they  are  replaced,  a  considerable  increase 
in  the  number  of  milliamperes  passing  through  the  hand  will  be 
found.    The  sensations  will  be  still  more  acutely  increased. 

Saturated  salt  water  is  about  three  thousand  times  a  better  con- 
ductor than  distilled  water;  hence  the  use  of  salted  water  on  electrodes 
increases  the  current  by  lessening  the  resistance  offered  by  the  con- 
ducting-joint  at  the  points  of  entrance  into  and  egress  from  the  body. 
It  is  of  great  service  when  the  batter3'-power  is  deficient  or  accident- 
ally low;  but  its  constant  use  is  inadvisable,  owing  to  the  dispropor- 
tionate increase  of  pain  produced  by  it  and  the  bad  effect  upon  the 
electrodes,  which  are  quickly  oxidized.  The  excess  of  pain  is  doubt- 
less due  to  the  irritant  effects  of  the  products  of  the  decomposed 
chloride  of  sodium. 

Effect  upon  the  Current  of  Different-Sized  Electrodes.  (Experi- 
ment 8). — Xote  the  number  of  milliamperes  passing  through  a  part 
of  the  body  from  the  full  strength  of  fifteen  cells, — (1)  when  two 
small  electrodes  are  used;  (2)  when  two  medium  ones  are  used;  (3) 
when  two  large  ones  are  used, — care  being  observed  to  place  them  in 
the  same  spots  and  press  their  whole  surface  in  contact. 

If  it  is  more  convenient  to  use  all  the  cells  in  the  way  advised  gen- 
erally in  this  work,  instead  of  using  the  full  strength  of  only  fifteen, 
it  may  be  done  by  simply  setting  the  controller  for  a  comfortable  cur- 
rent with  the  small  electrodes,  and  leaving  it  untouched  in  the  subse- 
quent steps  of  the  experiment. 

The  increase  of  current  when  the  larger  electrodes  are  used  is 
exceedingly  striking.  The  cuticle,  as  has  been  explained,  is  the  chief 
obstacle  to  the  current;  and  from  a  given  number  of  cells  but  a  cer- 
tain quantity  can  be  forced  through  each  square  inch  of  its  surface. 


EXi'EKlMKiN'J'AL    llAiNDLlNG    OF    GALVANIC    CUmiKNTS.  315 

The  more  square  inches  are  included  in  the  conducting  surface,  tliere- 
fore,  the  more  current  will  go  through  from  the  given  number  of 
cells;  but  there  will  be  no  increase  in  (and  possibly  a  slight  diminu- 
tion of)  the  number  of  milliamperes  passing  through  the  original 
square  inch  of  skin,  unless  the  number  of  cells  is  increased  or  the 
resistance  of  the  controller  lessened.  The  use  of  broad  electrodes  is 
indicated,  therefore,  whenever  we  wish  to  introduce  a  large  current 
into  the  body  with  a  minimum  of  pain  and  without  a  special  con- 
centration at  the  points  of  entry.  It  is  the  only  way  to  affect  deep 
structures  by  percutaneous  transmission  without  excessive  pain,  and 
for  such  purposes  both  electrodes  are  large.  In  gynecic  work,  where 
the  effect  of  a  single  "active"  pole  is  alone  desired,  the  other  "in- 
different" pole  is  made  sufficiently  large  to  secure  easy  penetration 
without  such  local  action. 

Comparison  of  the  Effect  of  the  Same  Current-strength  when 
Concentrated  and  Diffused.  (Experiment  9). — Connect  the  body 
with  the  positive  pole  of  the  battery  by  means  of  a  large  moistened 
electrode  on  its  surface.  This  will  form  the  indifferent  pole.  Select 
(1)  an  equally  large  moistened  electrode  for  the  active  pole;  place  it 
on  another  part  of  the  body;  connect  it  with  the  negative  terminal 
of  the  battery,  and  bring  the  current  up  to,  say,  eight  milliamperes, 
as  shown  in  the  meter.  Note  the  slight  pain  produced.  (2)  Exchange 
the  large  active  pole  for  a  medium-sized  one,  moistened  of  course,  and 
bring  the  current  up  to  the  eight  milliamperes.  The  pain  will  be 
increased,  owing  to  the  concentrated  action  of  the  same  number  of 
milliamperes.  (3)  Use'  next  a  fine  point  as  active  pole,  well  covered 
with  moist  cotton,  and  again  bring  up  the  current  to  eight  milliam- 
peres.   The  pain  is  quite  decided. 

As  the  size  of  the  active  pole  is  diminished,  the  current  being 
kept  the  same  by  adjusting  the  controller,  there  is  an  increase  in  the 
intensity  of  the  pain  corresponding  to  the  increased  density  at  this 
spot.  The  indifferent  pole  is  left  large  in  this  experiment,  as  in  so 
many  gynecic  applications,  because  it  combines  a  slight  resistance  to 
the  current  with  the  least  local  pain.  The  experiment  illustrates 
admirably  the  axiom  that  more  force  is  required  to  get  the  same- 
sized  current  through  a  small  place  than  through  a  large  one, — a 
principle  that  applies  self-evidently  to  most  things. 

Increase  of  pain  accompanies  with  great  certainty  an  increasing 
concentration  of  a  given  number  of  milliamperes  on  the  skin  surface; 


316  DISEASES    OF    WOMEN. 

but  it  should  not  be  forgotten  that  this  is  because  of  the  peculiar 
sensibility  with  which  the  body-sheath  is  endowed.  Beneath  it  and 
in  the  interior  of  less  sensitive  cavities  there  is  no  such  admonition 
to  guide  us;  hence  the  use  of  a  meter  becomes  more  imperative  in 
the  latter  situations,  for  the  current  is  just  as  active  whether  pain  is 
felt  or  not.  It  is  only  at  and  near  the  junction  of  mucous  membrane 
with  the  skin  surface,  such  as  the  lips,  vulva,  etc.,  that  great  sensi- 
tiveness to  currents  exists;  and  here  it  is  even  more  sensitive  than  on 
the  skin  surface,  in  accordance  with  a  fuller  endowment  of  sensitive 
nerve-filaments. 

Differing  Resistances  of  Skin  Surfaces.  (Experiment  10). — 
The  differences  in  the  resistance  offered  by  the  skin  of  various  parts 
of  the  body,  and  of  different  persons,  is  readily  shown  by  the  effect 
on  the  meter  at  each  position,  the  battery  and  controller  being  left 
undisturbed.  The  face,  inner  surface  of  the  limbs,  etc.,  will  show 
more  current  (presenting  less  resistance);  while  the  back  and  outer 
surfaces  of  the  limbs  will  show  less  current  (presenting  more  resist- 
ance), etc. 

That  these  differences  depend  almost  entirely  on  varying  thick- 
nesses of  cuticle  is  proven  by  the  showing  of  more  current  with  the 
poles  on  distant  but  thin  spots  than  when  alongside  of  each  other  on 
thicker  cuticle.  The  difference  between  corresponding  parts  of  the 
skin  of  different  individuals  is  also  at  times  considerable,  especially 
when  a  clear-skinned  blonde  and  pallid  brunette  are  compared. 

Comparison  of  the  Resistance  of  Skin  and  Mucous  Membrane. 
(Experiment  11).— Connect  but  a  small  number  of  cells,  say  fifteen, 
with  the  meter  and  controller,  in  order  that  the  full  strength  of  that 
number  of  cells  may  be  used.  Having  put  the  indifferent  pole  on  the 
abdomen  or  back,  cover  an  insulated-stemmed  vaginal  electrode  with 
absorbent  cotton,  wet  it,  and  direct  the  subject  of  the  experiment  to 
hold  it  between  the  bare  arm  and  chest  in  such  a  manner  that  the 
whole  conducting  surface  is  in  contact,  as  it  would  be  in  the  vagina. 
Turn  the  current  on  gradually  now  to  its  full  extent  by  means  of 
the  controller,  and  note  the  number  of  milliamperes.  Reverse  the  con- 
troller until  there  is  no  current,  and  introduce  the  electrode  into  the 
vagina.  The  current  may  then  be  again  increased  by  the  controller" 
to  its  full  capacity,  and  the  number  of  milliamperes  noted  in  this 
situation. 

A   marked   increase   in   the   milliamperes  will   be   noted   in   the 


EXPERIMENTAL    HANDLING    OF    GALVANIC    CURRENTS.  317 

vagiuo-abdominal  circuit  over  the  merely  percutaneous  one,  on  ac- 
count of  the  lessened  resistance  encountered  at  the  active  pole  when 

placed  in  contact  with  mucous  membrane. 

Alteration  of  Nerve-irritability  Within  each  Polar  Eegion. 
(Experiment  12).— Attach  two  medium-sized  electrodes  of  the  same 
dimensions  to  the  binding-posts,  place  them  (well  wetted)  on  the  skin 
over  each  peroneal  nerve  just  back  of  the  head  of  the  fibula,  and  in- 
crease the  current  to  five  or  ten  milliamperes. 

The  burning  pain  under  the  negative  electrode  is  in  distinct 
contrast  to  the  numb  sensation  under  the  positive. 

The  Effect  on  Nerves  of  a  Slowly  Varied  or  Continuous  Cnrrent 
Compared  with  that  of  a  Sudden  Current-variation.  (Experiment 
13). — Proceed  as  in  Experiment  l'-2,  noting  that  no  pain  or  motion 
is  produced  in  the  distant  parts  of  the  nerve  if  the  five  or  ten  milliam- 
peres have  been  attained  by  a  gradual  increase  from  zero.  With  the 
current  at  this  height  remove  now  one  of  the  electrodes  and  reapply 
it  (or  break  and  make  the  circuit  by  an  interrupter), — a  contraction 
will  be  produced  in  the  muscles  supplied  by  the  motor  fibres,  and  a 
sudden  sensation  in  the  areas  supplied  by  the  sensory  fibres  of  the 
nerves. 

The  actual  performance  of  these  and  similar  experiments  is  un- 
equaled  in  its  teaching  power.  Besides  familiarizing  one  with  many 
details  essential  to  successful  work  with  the  continuous  current, — sneh 
as  the  necessity  of  always  using  a  meter;  the  possibility  of  avoiding 
shock,  even  with  powerful  currents:  the  advantage  of  ample  battery- 
force  held  in  easy  check  by  a  controller:  and  the  wisdom  of  using 
large  and  small  electrodes  as  we  wish  non-local  or  local  effects, — ^it 
will  show  that  the  practice  of  electro-therapeutics,  while  relieved  of 
many  unnecessary  and  obsolete  theories,  may  still  remain  free  from 
the  formidable  task  still  imposed  by  some  recent  writers,  who  recom- 
mend that  the  resistance  of  the  tissues  be  calculated  and  recorded  in 
each  case.  As  well  might  they  say  that  we  should  measure  the  dark- 
ness in  a  room  rather  than  the  light  produced  in  the  effort  to  dispel 
it:  in  the  one  case  the  photometer  and  in  the  other  the  milliampere- 
meter  are  all-sufficient  to  convey  full  information  for  practical  pur- 
poses. 


CHAPTER  XXV. 

The  Faradic  Current, 

Mode  in  which  Faradic  Currents  are  Produced. — Faradic  cur- 
rents are  isolated  rises  of  pressure  in  a  wire,  produced  at  the  moment 
of  brealdng  or  making  tlie  galvanic  current  of  a  cell  which  circulates 
in  its  immediate  neighborhood.  This  current  is  named  after  Michael 
Faraday,  who  first  discovered  that  a  current  would  be  so  produced 
in  a  closed-wire  circuit  placed  over  or  close  to  another  in  which  a 
galvanic  current  was  varied.  The  strength  of  the  current  so  pro- 
duced is  proportional  to  the  strength  of  the  producing  current,  plus 
the  length  of  the  wire  subjected  to  the  influence  of  the  inducing  cur- 
rent-circuit; so  that  convenience  necessitates  the  coiling  of  one  in- 
sulated wire  about  the  other,  producing  a  solenoid,  or  induction  coil, 
in  which  many  feet  of  wire  occupy  but  a  small  space.  It  is  necessary 
that  the  two  wires,  carrying  the  inducing  and  induced  currents, 
should  be  close  to  each  other  and  properly  insulated  throughout. 
The  action  of  the  inducing  current  from  the  cell  in  the  first  coil  is 
increased  if  a  soft  iron  core  be  inserted  within  it,  making  what  is 
called  an  electro-magnet. 

In  a  simple  coil  of  but  few  turns,  or  in  two  straight  wires -placed 
close  to  each  other,  a  current  arises  in  one  direction  in  the  second 
wire  on  closing  the  cell-circuit  in  the  first,  and  another  current  arises 
in  the  other  direction  on  opening  the  cell-circuit.  The  current  that 
appears  in  the  secondary  coil  at  opening  the  cell-circuit  in  the  pri- 
mary is  direct,  or  in  the  same  direction  as  the  cell-current,  while  the 
current  that  appears  in  the  secondary  at  the  moment  of  closing  the 
cell-circuit  is  inverse.  The  primitive  faradic  current  is,  in  other 
words,  a  to-and-fro,  or  alternating,  current.  In  the  batteries  we  use 
this  is  also  true  of  the  currents  from  the  secondary  coil,  though,  for 
reasons  to  be  shown,  only  the  direct  currents  are  therapeutically  im- 
portant. An  equal  electromotive  force  and  an  equal  volume  arise  in 
each  direction,  causing  an  equal  amount  of  electrolysis  (which  is  thus 
continuously  neutralized),  yet  the  therapeutic  efFecis  are  very  dif- 
(318) 


THE    FARADIC    CUllRENT. 


319 


ferent  on  account  of  the  greater  abruptness  of  potential  rise  in  the 
direct  current;  and  as  the  only  purpose  for  which  faradic  currents 
are  used  in  medicine  is  the  muscle-  and  nerve-  stimulation  or  seda- 
tion that  a  minute  current  can  produce  when  very  suddenly  devel- 
oped, the  secondary  current  of  opening  is  practically  the  only  one 
used.^ 

A  faradic  battery  (Fig.  105)  consists  essentially  of  one  or  more 
galvanic  cells  placed  in  circuit  with  a  primary  insulated  wire  sur- 
rounding the  core,  and  with  an  automatic  device  to  alternately  break 
and  make  the  cell-current.    Over  the  primary  coil  is  slipped  a  bobbin 


Fig.  105. — Diagram  of  faradic  battery. 


having  another  coil  of  insulated  wire  wound  about  it.  This  second, 
or  secondary,  coil  has  no  metallic  connection  with  the  cell  or  the  cell- 
current,  deriving  its  current  by  induction  because  of  being  placed 
over  and  close  to  the  primary  coil  and  core.  The  operation  of  the 
apparatus  is  as  follows: — 

The  cell-current,  proceeding  from  the  carbon  pole  of  the  cell, 
traverses  the  primary  coil  and  returns  to  the  cell  through  the  in- 
terrupter, the  platinum  points  of  the  latter  being  in  contact.    In  the 


^  The  direct  current  of  opening  is  formed  and  completed  in  0.000275  sec- 
ond, while  the  inverse  current  of  closure  took  0.000485  second. 


320  DISEASES    OF    WOMEN. 

act  of  traversing  the  coil  this  current  makes  the  core  magnetic,  which 
in  turn  attracts  the  small  armature  on  the  interrupter,  breaking  the 
cell-current;  the  magnetism  of  the  core  having  now  disappeared,  the 
spring  returns  to  contact,  when  the  whole  process  is  repeated.  The 
rapidity  of  this  automatic  action  depends  on  many  factors  that  will 
be  referred  to  later.  At  the  instant  of  closure  of  the  cell-current  a 
reverse  induction  arises  in  the  secondary  coil,  but  this  rises  slowly 
on  account  of  what  is  called  self-induction  between  contiguous  wind- 
ings of  the  primary  coil.  At  the  instant  of  opening  the  cell-current 
a  direct  current  arises  in  the  secondary  coil  of  much  sharper  curve 
of  ascent  (because  there  is  but  little  self-induction  to  interfere  with 
it).  But  no  currents  arise  in  the  secondary  coil  unless  its  ends  are 
closed  by  a  patient  or  other  conductor  at  S  S. 

Eecurring  to  the  primary  coil,  it  will  be  noticed,  by  reference 
to  the  figure,  that  the  patient,  when  connected  by  electrodes  with  the 
primary  binding-posts  P  P,  is  placed  in  what  is  known  as  a  "shunt," 
or  parallel  circuit  with  the  primary  coil.  This  permits  an  infinitesimal 
amount  of  the  cell-current  to  traverse  the  tissues  when  the  spring  is 
in  contact;  but  since  the  resistance  of  the  coil  is  less  than  an  ohm 
and  that  of  the  patient  some  hundreds  of  ohms  it  will  be  seen  that 
practically  all  of  the  cell-current  will  take  the  short  road  through  the 
cell  instead  of  going  through  the  patient.  At  the  moment  of  closure 
of  the  cell-current  a  reverse  current  does  arise  in  the  primary  coil  by 
self-induction,  but  this  never  reaches  the  patient,  being  expended, 
as  already  stated,  in  blunting  the  sharpness  of  rise  of  pressure  in  the 
cell-current  a1>  closure.  When  the  cell-current  is  opened  at  the  in- 
terrupter, however,  the  primary  direct  induction  arising  in  the  pri- 
mary coil  has  no  recourse  but  to  traverse  the  patient  placed  in  con- 
nection with  the  binding-posts  at  P  P.  This  induced  current  of 
opening,  known  among  electricians  as  an  "extra  current,"  is  the  med- 
ical primary  current,  and  gets  much  of  its  force  from  the  demag- 
netization of  the  core;  and,  since  it  is  produced  in  a  coil  nearer  the 
core  than  any  secondary  wire  can  be,  the  volume  of  the  current  may 
be  greater,  other  factors  remaining  the  same.  The  direct  inductions 
only  can  reach  the  patient,  the  inverse  inductions  being  neutralized 
by  the  cell-current.  The  primary  current  is,  therefore,  not  in  any 
sense  an  aUernafin/]  nirrrnf. 

Means  of  Controlling  Farrdic  Currents. — In  the  sledge  or  du 
Bnis-Reymond  apparatus,  which  is  the  one  found  in  the  best  gynecic 


THE  FARADIC  CUKEENT.  321 

apparatUij  and  in  the  large  cabinets,  and  is  decidedly  tlie  best  form,  the 
secondary  coil  is  made  to  slide  over  the  primary,  the  inductions  in  the 
secondary  gradually  strengthening  as  the  secondary  windings  are  more 
and  more  subjected  to  the  influence  of  the  cell-current  in  the  primary 
coil  and  of  the  core.  To  slide  the  secondary  slowly  over  the  primary 
is,  therefore,  a  method  of  turning  the  secondary  current  on,  and  to 
slide  it  off  a  method  of  turning  it  off.  The  reverse  is  true  of  the 
primary  current,  which  is  weakest  when  the  secondary  completely 
covers  the  primary,  and  is  increased  by  uncovering  it.  The  secondary 
coil  thus  acts  as  a  damper  on  the  primary,^  abstracting  the  inductions 
to  itself.  An  old  form  of  Duchenne's  apparatus  provided  for  con- 
trolling the  current  by  covering  both  coils  with  a  tube,  which,  when 
a  complete  cylinder,  dampened  the  inductions  in  both  coils  and  core 
by  permitting  circular  inductions  around  its  own  circumference.  The 
cheaper  portable  apparatus  of  the  present  day  accomplish  the  same 
regulation  by  a  sliding  cylinder  covering  the  core  only,  but  both 
methods  of  regulating  with  cylinders  have  the  disadvantage  of  not 
reducing  the  currents  to  zero,  leaving  a  slight  shock  when  the  circuit 
is  closed  with  weakest  current. 

The  most  convenient  method  of  regulating  or  controlling  faradic 
currents  is  by  setting  the  coils  at  the  position  for  the  greatest  cur- 
rent of  the  kind  required  and  then  passing  the  current  through  the 
same  controller  employed  with  the  galvanic  current,  which  will  be 
found  to  answer  perfectly.  This  method  is  invariably  followed  by 
the  author. 

Though  so-called  faradometers  have  been  both  promised  and  con- 
structed, there  has  been  no  way  devised  to  measure  faradic  currents 
actually  traversing  the  patient,  owing  to  their  slight  volume  and  short 
duration.  Arbitrary  records  of  position  of  coils  are  employed  for 
comparison,  while  therapeutic  dosage  is  governed  mainly  by  the  effects 
obtained. 

The  Cell  and  Cell-CTirrent. — One  red-acid  or  two  chloride-of- 
ammonium  cells  are  usually  sufficient  to  operate  the  coils,  a  greater 
number  being  required  at  times  with  the  long  wire  coils.  The  zincs 
should  be  kept  in  order  and  brightly  amalgamated  and  the  solution 


'  The  secondary  coil  would  not  have  this  damping  effect  on  the  primary 
were  it  not  that  an  automatic  arrangement  closes  its  end  for  this  purpose, 
making  it  practically  a  tube. 


322 


DISEASES    OF    WOMEN. 


fresh,  as  the  work  of  these  cells  is  heavy,  uniformity  of  interrupter 
action  and  full  induction  requiring  that  about  half  an  ampere  should 
circulate  through  the  primary  coil.  Since  the  circuit  is  all  metallic 
outside  the  cell,  with  an  external  resistance  less  than  an  ohm,  one  or 
two  good  cells  will  suffice. 

The  Primary  Coil  and  Core. — The  proper  construction  of  faradic 
coils  is  Just  now  the  subject  of  much  discussion  in  electro-therapeutic 
circles,  a  standing  committee  having  been  appointed  by  the  American 
Electro-Therapeutic  Association  to  conduct  investigations,  and  while 


Fig.  106. — Flemming's  No.  4  faradic  battery,  possessing  a  high-tension  coil 
and  excellent  primary,  controlled  by  the  du  Bois-Reymond  slide. 


it  is  beyond  the  scope  of  this  work  to  enter  into  technical  discussions 
that  would  be  too  voluminous  for  its  pages,  the  growing  importance 
of  these  currents  in  gynecology  necessitates  a  succinct  statement  of 
the  features  that  are  at  present  thought  to  be  essential  in  a  properly- 
constructed  gynecic  apparatus.  It  is  too  true,  as  stated  by  Goelet  and 
Engelmann,  that  the  great  majority  of  physicians  have  purchased, 
and  are  still  purchasing,  apparatus  that  is  practically  worthless  for 
gynecic  purposes.  Even  much  of  the  best  apparatus  recommended 
by  these  authors  has  too  small  a  primary  coil  and  core  to  give  a  really 
powerful  contracting  primary  current.     The  most  useful  size  of  pri- 


THE  FARADIC  CURRENT. 


323 


mary  coil,  in  the  author's  experience,  is  that  usually  found  in  the 
Flemming  No.  4  faradic  battery  and  his  cabinet  apparatus.  The 
dimensions  are:  length  of  core,  5^  inches;  thickness  of  core,  f  inch; 
the  coil  contains  120  feet  of  No.  18  copper  wire,  wound  in  four 
windings.  The  resistance  of  the  coil  is  eight-tenths  of  an  ohm.  It 
is  likely  that  these  proportions  are  nearly  correct,  as  no  additional 
contracting  power  was  gained  in  several  experimental  coils,  either 


Fig.   107. — Mcintosh  faradic  battery. 


by  doubling  the  length  of  core  and  coil  or  by  changes  in  the  size  or 
length  of  the  wire. 

Primary  Current. — Since  the  primary  coil  is  made  of  a  compara- 
tively short  thick  wire,  permitting  of  but  few  turns  about  the  core, 
the  electromotive  force  developed  in  it  is  not  nearly  so  high  as  in 
the  secondary  coil.  Its  nearness  to  the  core  results  in  heavy  amperage 
in  comparison  to  the  latter  coil,  however,  which  is  rendered  greater 
by  the  slight  resistance  of  the  short  thick  wire.  In  regulating  it  with 
the  Massey  controller  the  secondary  coil  is  removed  all  the  way,  or 


324 


DISEASES    OF    WOMEN. 


to  the  greatest  extent  desired,  and  the  controller  turned  on  until  a 
sufficient  contraction  is  obtained.  Owing  to  the  low  pressure,  it  will 
be  noted,  no  current  is  felt  until  the  controller  is  half-turned  on,  but 
the  current  increases  with  augmented  rapidity  as  the  point  of  no  re- 
sistance is  reached.  The  converse  is  true  with  the  high-pressure 
currents  of  the  secondar}^  coil,  most  care  being  required  to  make  the 
increase  gradual  at  the  beginning  of  the  graphite  area. 

Uses. — The  primary  current  is  indicated  whenever  we  wish  to 
produce  fullest  contractions  of  muscular  tissue,  whether  striated  or 


Fig.   108.— End-view  of  Rockwell's  high-tension  coil,  as  made  by 
the  Jerome  Kidder  Manufacturing  Company. 


unstriated,  provided  the  total  resistance  of  the  circuit  is  not  great. 
When  applied  through  externally  placed  electrodes,  therefore,  we 
must  use  large  well-moistened  pads,  and,  if  it  be  monopolar,  the  in- 
different pad  must  be  large.  It  is  particularly  adapted  to  bipolar 
work,  owing  to  the  small  resistance  between  the  electrode  surfaces, 
and  is  indicated  in  recent  subinvolution  and  in  atonic  conditions  of 
the  bowels  and  bladder. 

The  Secondary  Coil  and  Current. — As  already  stated,  the  sec- 
ondary coil  must  be  made  of  a  long  fine  wire  if  a  considerable  electro- 


THE    FAEADIC    CUllRENT. 


325 


motive  force  (as  yet  not  accurately  measured)  is  to  be  developed  for 
use  in  producing  sensory  and  vascular  sedation.  Currents  from  very 
long  vi^ires  are  best  for  use  in  conditions  of  semi-acute  irritation,  when 
rapidly  successive  inductions  of  high  pressure  and  extremely  small 
volume  only  are  bearable.  As  a  condition  of  greater  tolerance  is 
established  a  moria  distinctly  contractile  current  will  give  increased 
curative  effects;  hence  an  instrument  for  gynecic  use  should  have 
several  interchangeable  secondary  coils  to  choose  from,  the  coil 
adapted  to  the  case  being  slipped  over  the  primary  as  required.  The 
earliest  effort  in  this  direction  in  this  country  was  the  portable  faradic 


Fig.   109. — Engelmann's  faradic  battery. 


apparatus  of  Dr.  George  J.  Engelmann,  formerly  of  St.  Louis,  in 
which  three  secondary  coils  were  used. 

The  Engelmann  Coils.— l^o.  1,  coarse  wire  coil,  is  made  of  No. 
16  wire,  about  225  feet  long.  This  is  used  for  motor  stimulation, 
though  a  good  primary  coil  will  do  better  work  of  a  similar  kind. 

No.  2;  intermediate  coil.  This  is  made  of  No.  21  wire,  about 
675  feet  long,  and  produces  less  painful  contractions. 

No.  3;  fine-wire  coil.  This  is  made  of  No.  31  wire,  1980  feet 
long,  and  the  effect  is  moderately  sedative. 

The  Goelet  Coils. — Owing  to  the  possibility  of  obtaining  greater 


326  DISEASES    OF    WOMEN. 

sedation  by  a  still  longer  wire  in  the  fine  coil.  Dr.  A.  H.  Goelet,  of 
New  York,  has  introduced  a  set  of  three  coils  of  still  greater  elabora- 
tion, the  two  fine  spools  having  switches  on  the  end,  permitting  of 
the  tapping  and  using  of  different  lengths  of  wire  from  the  same  coil. 
J  hey  are  constructed  as  follows: — 

Coarse  coil,  No.  22  wire,  750  feet  long. 

Intermediate  coil,  No.  32  wire,  2400  feet  long,  tapped  at  1600 
feet  and  900  feet. 

Fine  coil.  No.  36  wire,  4500  feet  long,  taped  at  3000  feet  and 
1500  feet. 

The  Goelet  coils,  when  supplied  with  a  properly-made  primary 
coil  and  core,  leave  nothing  to  be  desired  in  their  adaptation  to  the 
most  varied  therapeutic  indications. 

The  Interrupter,  or  Rheotome. — This  is  a  most  important  part 
of  a  good  gynecic  apparatus  and  is  unfortunately  seldom  what  it 
should  be.  I  am  convinced  that  the  simple  vibrating  spring-hammer 
of  Neef,  which  is  the  kind  usually  found  on  even  the  best  batteries, 
should  be  abandoned  entirely  in  favor  of  what  I  have  called  the  bow- 
string interrupter  of  Flemming,  or  else  of  the  "singing  rheotome"  of 
the  Galvano-Faradic  Co.  The  bow-string  interrupter  is  simply  an 
extension  of  the  spring  to  double  its  length,  both  ends  being  attached 
to  posts,  to  one  of  which  a  tension-screw  is  attached  to  increase  or 
lessen  the  tension  of  the  spring  and  thus  regulate  the  time  of  the 
vibrations.  The  armature  is  attached  to  the  middle  of  the  brass  spring 
and  the  platinum  plate  for  contact  near  the  fixed  post.  Besides  regu- 
lating the  frequency  and  amplitude  of  the  vibrations  by  the  tension- 
screw,  we  regulate  them  also  with  the  set-screw  carrying  the  platinum 
contact-point.  This  device  gives  easily  the  rate  of  vibration  suitable 
for  muscular  contraction,  which  is  from  1  to  about  3000  per  minute, 
and  this  rate  serves  well  for  sensory  sedation  if  the  fine  coils  are  used. 
According  to  d'Arsonval,  the  highest  stimulation  may  be  obtained 
from  a  suitable  coil  between  3000  and  4000  interruptions  per  minute, 
the  stimulation  decreasing  with  a  further  increase  of  the  rate  until 
with  7000  to  9000  interruptions  of  a  medium  current  it  is  no  longer 
felt.  Vibrations  above  3000  per  minute  are  therefore  sedative  rather 
than  stimulating,  the  separate  excitations  of  muscle  and  nerve  blend- 
ing together,  muscular  excitation  finally  ceasing,  and  the  sensory  ex- 
citation changing  into  a  numbness. 

There  is  no  really  practical  means  of  measuring  the  rate  of 


THE  FARADIC  CURRENT.  337 

vibration  of  springs,  however,  the  low  or  high  note  emitted  by  them 
being  the  most  convenient  method  of  approximate  estimation.  Eegu- 
larity  of  rate,  with  consequent  regularity  of  current-rise  and  fall,  is 
particularly  essential,  not  only  in  sedation  with  high-frequency  cur- 
rents but  for  painless  contraction;  hence  a  spring  that  gives  a  con- 
fused or  jarring  note  should  be  discarded  for  one  that  can  be  adjusted 
and  maintained  to  a  clear  note,  whether  low  or  high.    With  all  springs, 


Fig.  110. — De  Watteville  combiner,  to  which  is  added  a  pole-changer, 
or  commutator,  with  index  pointing  to  the  negative  pole. 

however,  there  seems  to  be  an  unfortunate  liability  to  sudden  changes 
when  the  relative  position  of  the  coils  is  changed  during  a  seance. 
To  get  rid  of  these  disadvantages  Engelmann  has  revived  the 
wheel-interrupter,  worked  by  an  electric  motor  and  easily  capable  of 
regulation  and  record  of  frequency.  This  apparatus  gives  promise  of 
being  highly  useful,  though  I  have,  as  yet,  had  no  experience  with  it. 
Such  a  method  of  current-interruption  enables  us  also  to  get  a  wider 
range  of  currents  from  the  ordinary  coils,  since  a  one-way  primary 
current  may  be  obtained  from  any  secondary  coil  by  sending  a  suf- 
ficiently strong  cell-current  through  it.^ 


^  See  Medical  News,  February  3,  1894. 


328  DISEASES    OF    WOMEN. 

Polarity  of  the  Faradic  Current. — The  primary  current  of  a 
faradic  coil  has  as  distinct  a  polarity  as  the  galvanic,  being  always 
in  one  direction,  as  explained  above.  The  secondary  currents  have 
also  a  distinct  polarity  in  their  •  physiologic  action,  though  not  so 
marked  as  is  the  primary,  the  direct  inductions  being  stronger  and 
more  abruptly  produced  than  the  inverse  inductions.  The  electrode 
attached  to  the  negative  pole  of  either  current  will,  therefore,  be  found 
to  be  the  most  stimulating  when  applied  to  nerves  and  muscles,  and 
the  positive  most  sedative. 

Indications  for  the  Use  of  Covered  and  Bare  Electrodes  with 
Faradic  Currents. — The  use  of  a  moist  conductor  to  convey  the  faradic 
current  through  the  skin  to  nerves  and  muscles  beneath  it  is  fully  as 
important  as  in  the  case  of  the  galvanic  current;  for,  although  the 
former  current  leaps  from  a  dry  metallic  disk  to  the  skin  with  great 
facility,  and  is  therefore  best  adapted  to  the  dry-brush  method  of 
stimulation,  it  expends  its  action  at  such  times  almost  entirely  on 
the  dermic  surface  and  nerve-ends,  the  polar  region  being  extremely 
superficial.  The  moist  covering  permits  a  greater  penetration  and  ex- 
tension of  this  region;  hence,  a  deeper  action  with  less  surface  pain. 
Within  moist  cavities,  however,  the  use  of  a  moistened  covering  on 
the  exposed  conducting  surface  of  the  electrode  is  totally  unnecessary, 
as  the  moisture  of  the  cavity  itself  readily  favors  this  distribution  of 
the  current.  The  bare  electrode  is,  moreover,  introduced  into  such 
cavities  with  greater  ease.  The  handles  of  such  electrodes  should,  of 
course,  be  properly  insulated,  to  protect  the  vulva  and  other  parts  not 
designed  to  be  affected. 

Experimental  Comparison  of  the  Electromotive  Force,  or  "Press- 
ure," of  the  Faradic  Current  with  that  of  the  Galvanic  Current. 
(Experiment  14). — This  may  be  roughly  done  by  touching  simul- 
taneously, with  dry  fingers,  the  bare  terminal  wires  of  a  full-strength 
galvanic  battery.  No  current  is  felt,  since  the  sixty  to  ninety  volts 
of  pressure  in  such  a  galvanic  current  are  not  sufficient  to  make  the 
current  jump  through  the  minute  layer  of  air  between  the  finger  and 
the  wire;  moist  fingers  permit  a  little  to  get  through.  If,  now,  the 
dry  fingers  be  simultaneously  brought  in  contact  with  the  bare  ter- 
minals of  a  faradic  current  of  merely  medium  strength  considerable 
tingling  will  result;  its  pressure  is  amply  sufficient  to  cause  it  to  leap 
through  this  air-space. 

There  are  two  practical  applications  of  this  fact  besides  its  dem- 


THE  FARADIC  CURRENT.  329 

onstration  of  the  main  quality  of  electromotive  jjressure:  one  indicates 
the  need  of  a  more  careful  insulation  of  the  faradic  current  to  pre- 
vent accidental  shocks;  and  the  other,  the  greater  adaptability  of 
this  current  for  the  electric-brush  application  to  the  body-surface. 

Action  of  the  Faradic  Current  on  Sensory  Nerves  and  Muscles. 
— Notwithstanding  the  exceeding  weakness  of  this  current  in  "Tsulk" 
or  "volume,"  the  great  requisite  for  usefulness  in  the  mechanic  arts 
and  in  the  chemic  destruction  and  metamorphosis  of  tissue,  a  slight 
acquaintance  with  its  action  on  any  part  of  the  body  is  apt  to  impart 
an  exaggerated  idea  of  its  physiologic  powers.  Being  essentially  a 
series  of  exceedingly  abrupt  current-creations,  its  power  to  excite  the 
functions  of  nerves  and  muscles  is  unique,  and  the  manifest  phe- 
nomena of  pain  and  muscular  contraction  conceal  its  total  inability 
to  produce  profounder  impressions  on  the  body.  A  nerve  or  muscle, 
brought  within  either  polar  region,  is  thrown  into  action  as  each 
induction  arises,  just  as  an  abrupt  variation  of  the  galvanic  current, 
whether  a  rise  or  fall,  produces  a  similar  phenomenon.  Each  induc- 
tion produces  a  separate  stimulus,  therefore,  and  it  is  only  when  they 
follow  each  other  very  rapidly,  as  when  a  rapid  interrupter  is  used, 
that  the  separate  stimulations  seem  to  blend  together,  producing  a 
continuous  contraction  or  sensation.  Even  then  the  impressions  on 
the  nerve  are  those  of  distinctly-separated,  though  rapidly-successive, 
currents.  The  sedative  effect  produced  by  high-frequency  currents 
from  the  fine  coil  is  probably  of  the  nature  of  a  temporary  anesthesia 
of  the  terminal  sensory  apparatus. 

The  faradic  susceptibility  of  the  sensory  nerves  of  the  limbs  and 
trunk  is  fully  shared  by  those  of  the  pelvis,  although  the  lessened 
sensibility  of  the  normal  uterine  and  ovarian  nerves  permits  the  em- 
ployment of  current-strengths  not  bearable  on  the  skin  surface.  The 
vulva,  on  the  contrary,  like  other  muco-epidermic  junctions,  is  ex- 
quisitely sensitive  to  this  stimulus,  and  should  be  protected  from  it 
in  all  ordinary  applications  by  well-insulated  electrode  stems.  The 
sensibility  of  .the  vagina  is  about  midway  between  the  two. 

Therapeutic  TJses. — This  current  acts  only  on  nerves  and  muscles, 
stimulating  each  into  action  or  developing  anesthetic  effects,  and 
its  use  is,  therefore,  limited  strictly  to  such  conditions  as  exhibit 
nervous  or  muscular  laxity  or  pain.  But  is  this  limitation  a  very 
narrow  one?  How  many  of  the  commoner  cases  met  in  daily  prac- 
tice present  just  these  shortcomings,  especially  those  encountered  in 


330  DISEASES    OF    WOMEN. 

a  public  clinic?  The  case  after  case  of  displaced  and  prolapsed  uteri 
that  present  themselves,  with  or  without  rectocele  or  vesicocele,  and 
with  intact  perinei,  teach  the  paramount  importance  of  muscular  tone 
of  the  vaginal  walls  and  uterine  ligaments  in  the  maintenance  of  a 
normal  condition.  When  this  tone  has  been  lost,  it  is  evidently  the 
part  of  rational  medicine  to  endeavor  to  restore  it,  if  possible, — not 
to  prolong  and  intensify  it  by  erecting  a  false  skeleton  with  a  pessary 
or  tampon  within  the  vagina. 

Properly  constructed  bipolar  electrodes  are  peculiarly  efficient  in 
attaining  this  contractile  action  on  relaxed  pelvic  muscles,  inclusive 
of  the  uterus  itself.  Bipolar  vaginal  applications  may  be  with  the 
coarse-wire  coil  or  primary  current  if  there  is  no  inflammatory  con- 
ditions present,  but  in  the  latter  case  the  pain  and  violent  contrac- 
tions produced  by  these  currents  are  capable  of  increasing  the  mis- 
chief. The  combination  of  mild  contractile  and  anesthetic  effects 
obtained  from  a  similar  use  of  fine-wire  currents  is,  on  the  contrary, 
most  beneficial,  even  in  subacute  inflammation;  hence  bipolar  fine- 
wire  currents  are  useful  in  a  large  number  of  cases,  the  simple  anes- 
thetic effects  rendering  them  invaluable  in  either  inflammatory  or  non- 
inflammatory neuralgias. 

Electrodes  and  Dosage. — As  a  rule,  the  active  electrodes  required 
for  galvanic  applications  may  be  used  for  this  current,  and  a  similar 
dispersion  of  current  at  the  indifferent  pole  is  advisable  when  used 
after  the  monopolar  method.  The  absorbent-cotton  pad  will,  of 
course,  be  more  convenient  than  the  clay  if  a  faradic  current  only  is 
to  be  used. 

The  only  electrodes  peculiar  to  the  faradic  current,  and  which 
should  not  be  used  with  other  currents,  are  the  bipolar  electrodes, 
of  which  the  one  for  use  within  the  vagina  is  the  most  commonly 
employed.  Apostoli's  bipolar  vaginal  electrode  as  modified  by  Goelet 
(Fig.  22)  is  decidedly  the  best.  In  this  instrument  the  designer  has 
adopted  the  bulbous  projections  suggested  by  me  to  make  better  con- 
tact with  the  mucous  membrane,  and  has  also  altered  the  relative  pro- 
portions in  such  a  way  that  the  instrument  is  practically  self-sustain- 
ing within  the  vagina. 

Apostoli's  intra-uterine  bipolar  electrode  (Fig.  27)  remains  the 
best  in  design,  but  all  intra-uterine  bipolar  electrodes  are  clumsy  and 
difficult  to  thoroughly  asepticize. 

The  selection  of  the  dose  is  purely  empirical,  as  we  have,  at 


THE  FAEADIC  CURRENT.  331 

present,  no  means  to  measure  this  current  beyond  the  individual 
scale  of  each  instrument.  The  best  guide  to  the  strength  required 
in  a  given  case  is  gained  from  the  sensations  of  the  patient,  the  cur- 
rent having  been  brought  up  from  zero  to  the  point  of  easy  tolerance, 
after  placing  the  electrodes  in  position,  in  the  same  gradual  manner 
as  advised  for  galvanic  applications.  If  we  do  not  shock  by  a  sudden 
turning  on  or  off,  there  is  no  possible  way  in  which  the  patient  can 
be  harmed;  so  that  our  main  point  in  muscular  applications  is  to 
use  as  much  current  as  the  patient  will  bear,  and  it  is  astonishing 
how  much  can  be  given  in  this  way  with  one  pole  in  the  vagina  or 
uterus  and  a  large  dispersion  on  the  abdomen.  "Weaker  currents  are 
better  for  neuralgic  conditions,  as  a  rule.  The  milliamperemeter  is, 
of  course,  useless  with  this  current. 


CHAPTER  XXVI. 

Feaxklinic,  or  Static,  Electricity. 

Physics. — The  electricity  produced  by  static  machines  is  of  ex- 
ceedingly high  pressure  (53,000  volts  per  centimetre  of  spark-length, 
according  to  Lord  Kelvin)  and  very  slight  volume  (five-thousandths 
of  a  milliampere  to  a  quarter-inch  spark,  according  to  Sprague), 
though  the  volume  per  spark-length  really  varies  with  the  number 
of  plates  in  the  machine.  With  a  current  possessing  such  an  in- 
finitesimal volume  it  will  be  seen  that  the  principal  therapeutic  effects 
are  due  to  an  inconceivably  high  polarization  of  nerve  and  muscle. 
When  the  spark  is  applied  to  the  dry  body  it  undoubtedly  disrupts 
the  cuticle  on  its  way  to  the  moist  tissues  that  act  as  the  surface  of 
the  conductor,  the  surface  nerves  of  sensation  receiving  the  brunt  of 
the  excitation;  but  if  moist  electrodes  be  employed,  as  first  suggested 
by  Morton,  the  spark  is  conveyed  through  the  skin  by  conduction 
rather  than  disruption  and  deeper  nerves  and  muscles  are  then  readily 
reached,  as  with  other  currents.  Since  the  volume  of  these  currents 
is  so  slight,  it  is,  of  course,  essential  that  an  interruption  of  the  cur- 
rent, or  sparking  space,  must  exist  somewhere  in  the  circuit  with  the 
patient  for  any  action  to  be  manifest,  the  completely  closed  external 
circuit  giving  us  a  galvanic,  or  continuous,  current  of  only  five-thou- 
sandths of  a  milliampere,^  which  is  practically  nothing. 

There  is,  however,  another  important  physical  effect  produced 
by  this  form  of  electricity  besides  the  polarization  of  nerve  and  muscle 
by  transmitted  currents.  This  is  the  static  effect  of  the  charge  on 
the  body-surface  when  sparks  are  not  used.  The  equally-diffused 
charge  as  in  static  electrization,  and  particularly  the  concentrated 
charge  on  the  portion  of  the  body  opposite  the  electrode  administering 


'  This  calculation  of  the  niilliamp&rage  of  franklinic  currents  was  made 
from  old  machines,  and  is  doubtless  much  greater   with   the  many-plate  ma- 
chines now  used. 
(332) 


FRANKLINIC,    Oil    STATIC,    ELECTRICITY.  333 

a  spray,  have  peculiar  and  yet  but  imperfectly  explained  actions  on 
surface-nerves  and  tissues. 

For  a  full  explanation  of  the  principles  involved  in  the  operation 
of  a  static,  or  influence,  machine  the  reader  is  referred  to  more  com- 
prehensive works  on  electro-physics.  The  machine  may  be  described 
in  brief  as  similar  in  operation  to  a  dynamo,  a  minute  charge  given 
to  a  paper-element  inducing  a  reciprocal  charge  on  the  nearest  por- 
tion of  a  revolving  plate,  which,  by  rapid  revolution  and  reaction 
effects,  multiplies  the  charge  to  a  full  load. 

The  paper  elements  on  the  stationary  plates  of  the  main  machine 
are  analogous  to  the  field-magnets  of  the  dynamo  and  the  revolving 
plates  to  the  armature.  The  medical  influence  machines  now  made 
on  a  large  scale  in  America  are  merely  an  improvement  of  the  Holtz 
pattern,  in  which  the  principle  of  induction  was  substituted  for  fric- 
tion about  1865,  the  improvements  consisting  in  multiplying  the 
plates,  protection  from  atmospheric  influences,  and  perfecting  the 
mechanical  features.  The  revolving  plates  are  plain  discs  of  glass, 
coated  with  shellac,  which  permit  of  the  greatest  development  of  an 
initial  charge,  though  it  has  been  found  that  the  Wimshurst  improve- 
ment is  superior  in  the  development  of  this  initial  charge,  though 
inferior  in  its  multiplication.  The  most  perfect  apparatus  now  con- 
sists of  two  separate  machines,  placed  in  the  same  cabinet,  but 
preferably  in  separate  compartments,  the  Wimshurst  machine  being 
merely  used  as  a  charger  when  the  main  battery  has  lost  its  charge. 
Analogous  combinations  are  frequently  found  in  dynamo-houses. 

Selection  and  Care  of  the  Static  Machine. — The  author  has  fre- 
quently been  asked  if  a  static  machine  is  a  necessary  adjunct  to  an 
office  outfit  in  the  practice  of  neuro-gynecology.  Though  skeptical 
originally  on  this  point  himself,  a  long  experience  has  convinced  him 
that  it  is  of  far  more  relative  importance  than  a  faradic  outfit,  though 
still  far  beneath  the  galvanic  apparatus  in  relative  value.  Compari- 
sons are  of  but  little  moment  in  such  matters,  however,  the  indica- 
tions for  the  use  of  each  current  being  usually  distinct  and  separable. 
No  office  is  thoroughly  equipped  for  good  work  without  all  three  of 
these  currents. 

In  the  selection  of  a  machine  it  should  be  understood  that  the 
electromotive  force  of  the  current  is  determined  by  the  diameter  of 
the  revolving  plates  and  its  volume  by  the  number  of  these  plates. 
Now,  a  most  important  form  of  treatment  in  peurasthenia  and  allied 


334 


DISEASES    OF    WOMEN. 


conditions  is  the  static  spray  and  static  charge,  and,  while  adequate 
sparks  may  be  applied  from  machines  of  but  moderate  size,  these  two 
procedures  demand  that  the  machines  shall  possess  at  least  six  revolv- 
ing plates,  which  shall  be  at  least  thirty  inches  in  diameter.     These 


Fig.  111.— Type  of  the  Waite  &  Bartlett  and  Van  Houten  &  Ten  Broeck 
multiple  plate  static  machines. 


details  are  really  as  important  as  the  number  and  efficiency  of  the  cells 
of  a  galvanic  battery. 

Secondly,  it  should  be  remembered  that  these  generators  of  elec- 
tricity consume  nothing  but  the  power  required  to  turn  them,  the 


FRANKLINIC,    OR    STATIC,    ELECTRICITY.  335 

current  being  developed  by  the  motion  of  parts  composed  of  specially 
adapted  materials  under  narrowly  defined  conditions  of  dryness  and 
cleanliness.  It  follows  that  too  much  skill  cannot  be  expended  in  the 
purely  mechanical  parts  of  the  machine  to  insure  proper  wear  under 
the  necessary  motion,  and  that  the  user  should  exercise  reasonable 
care  in  maintaining  the  proper  adjustment  of  the  stationary  plates  to 
prevent  harmful  friction  between  the  several  parts,  proper  adjustment 
of  the  belt,  and  the  dryest  attainable  air-space  within  the  case.  This 
latter  is  best  maintained  by  several  dishes  of  the  anhydrous  chloride 
of  calcium,  which  should  be  heated  to  dryness  when  deliquescent. 

A  most  important  reason  for  the  selection  of  the  largest  and  best 
static  machine  for  therapeutic  work  is  that  this  otherwise  useful  ap- 
paratus forms  also  a  most  valuable  means  of  developing  the  x-rays 
of  Eoentgen  with  but  slight  additional  expense  for  the  tube  and 
fluoroscope,  thus  rendering  a  special  coil  unnecessary  for  this  purpose. 

The  large  machines  now  produced  in  America  are  far  superior 
to  any  of  foreign  make  that  the  author  has  used,  but  some  of  them 
are  still  in  the  transition  stages  of  mechanical  development.  The  two 
most  popular  machines  at  present  are  those  manufactured  by  Van 
Houten  &  Ten  Broeck,  and  Waite  &  Bartlett,  both  of  New  York  City. 
The  types  of  these  machines  are  quite  similar  in  essential  parts,  the 
generator  of  each  being  constructed  of  rotating  and  stationary  plates 
of  glass,  closely  imitating  the  original  Holtz  static  machine,  with  small 
chargers  in  each  case  built  on  the  pattern  of  the  more  recent  Wims- 
hurst  machine.  The  purpose  of  thus  having  two  machines  in  each 
case  lies  in  the  value  of  the  Wimshurst  type  of  construction  as  an 
ever-ready  generator,  the  Holtz  type  frequently  losing  its  initial  charge 
over  night  and  requiring  to  have  it  resupplied.  The  Holtz  type,  on 
the  other  hand,  is  best  adapted  to  multiply  this  initial  charge  into  the 
voluminous  supply  required  in  therapeutics.  In  practice  the  "Wims- 
hurst charge  is  only  rotated  when  the  main  Holtz  mechanism  fails  to 
supply  current,  and  the  smaller  machine  is  put  out  of  action  as  soon 
as  the  charge  is  resupplied  to  the  main  battery  of  plates. 

R.  V.  Wagner,  of  Chicago,  has  recently  placed  on  the  market  a 
machine  quite  similar  to  those  mentioned  except  that  the  revolving 
and  stationary  plates  are  composed  of  compressed  sheets  of  mica  and 
shellac.  The  author  has  observed  this  machine  in  action  and  doing 
good  work,  but  is  not  in  possession  of  any  data  to  establish  its  advan- 
tage over  the  well-tried  glass  machines. 


336  DISEASES    OF    WOMEN. 

The  author  would  not  advise  less  than  eight  plates  for  any  of  these 
machines,  and  an  increase  to  ten  plates  (the  revolving  plates  only 
being  counted)  will  render  a  full  supply  of  current  possible  without 
the  necessity  of  running  the  machine  at  a  nerve-racking  speed. 

An  electric  motor  is,  of  course,  the  most  convenient  means  of 
operating  static  machines,  though  a  water-motor,  gas-engine,  or  the 
oliice-boy  will  suffice.  With  the  former  means  it  is  essential  that 
proper  devices  be  supplied  for  regulating  the  speed,  as  the  exigences 
of  various  cases  demand  that  the  machine  be  driven  at  various  speeds, 
from  mere  motion  to  high  speed.  The  tremor  and  unpleasant  buzzing 
sound  at  times  produced  at  high  speed  should  be  avoided  if  possible, 
as  it  is  liable  to  be  unpleasant  to  a  sensitive  patient. 

Methods  of  Application. — In  all  applications  the  patient  sits  or 
stands  on  an  insulated  platform  (which  should  be  elevated  from  the 
floor  by  solid  glass  legs),  and  the  platform  or  projecting  portions  of 
clothing  should  not  be  closer  than  two  feet  from  the  machine-case 
or  other  furniture  to  prevent  leakage. 

Much  confusion  has  resulted  from  various  directions  given  by 
writers  as  to  the  proper  method  of  connecting  the  patient  with  the 
machine,  a  recent  author  of  a  very  ambitious  work  devoted  to  this 
current  alone  specifying  that  one  pole  should  always  be  grounded  by 
connection  with  a  water-pipe  or  gas-fixture,  and  pictures  elaborate 
wiring  of  his  office  for  this  purpose.  He  even  goes  further  than  this, 
and  specifies  at  least  two  simultaneous  "groundings"  of  opposite  poles 
at  times;  but  where  he  gets  the  other  earth  for  a  connection  does  not 
appear,  though  a  different  set  of  pipes  communicating  with  the  same 
cellar-floor  seems  to  be  meant.  The  way  out  of  this  sorry  confusion 
is  to  remember  that  the  current  from  this  machine  obeys  laws  exactly 
similar  to  those  of  all  other  electric  currents;  and,  while  it  may  take 
the  circuitous  route  through  the  cellar,  a  better  one  is  the  direct  metal 
route  via  the  chains  and  rods  back  to  the  other  pole.  It  is  impossible 
to  increase  the  efficiency  of  a  machine  during  any  direct  method  of 
treatment  {e.g.,  the  spray  or  sparks)  by  including  pipes,  the  earth, 
etc.,  in  the  circuit,  the  whole  current  being  produced  by  the  machine 
tearing  apart  the  ether  within  itself.  What  has  been  mistakenly 
regarded  as  a  ground  is  the  direct  electrization  of  the  walls  of  the 
room  surrounding  the  static  machine  by  connecting  the  opposite  pole 
to  it  during  the  first  procedure  to  be  described, — the  static  charge, — 
which  is  weak  unless  the  walls  of  the  room  are  made  a  condenser  by 


FRANKLINIC,    OR    STATIC,    ELECTRICITY. 


337 


direct  connection  with  the  opposite  pole;  and  this  is  best  done  by 
attaching  the  chain  to  a  good  metallic  reservoir,  such  as  a  pipe,  im- 
bedded within  it.     With  this  exception,  all  methods  of  application 


Fig.  112. — Electrodes  for  use  with  static  machine,  with  platform  for 
patient,  the  latter  being  insulated  twelve  inches  by  solid  glass  legs,  i, 
aluminized  telescoping  standard,  with  aluminum  ball  and  point  electrodes 
for  stationary  treatment  with  spark  and  spray  a,nd  for  support  of  umbrella 
for  head-breeze.  2,  aluminum  hand-massage  roller  electrode.  3,  aluminum 
hand  ball  electrode  for  applying  sparks.  4,  aluminum  hand  point  electrode 
for  applying  spray.  5,  aluminum  hand  brush  electrode  for  applying  mov- 
able breeze.  6,  aluminum  and  glass  director  electrode  for  internal  applica- 
tion of  sparks  or  spray.  7,  hand  sponge  electrodes  for  Morton's  induced 
current.  8,  shepherd's  crook,  and  chains  for  connecting  platform  or  patient 
with  prime  conductor  of  machine  and  electrode. 


338  DISEASES    OF    WOMEN. 

are  exactly  analogous  to  the  method  of  a  "dispersing"  and  an  "active" 
electrode,  though  I  frequently  moderate  the  spark  treatment  by  in- 
terposing a  longer  or  shorter  floor-space  in  the  circuit.  This  is  done 
by  dropping  an  end  of  the  chain  from  the  active  prime  conductor 
to  the  floor;  near  it  rests  the  end  of  another  chain  connected  with 
the  active  electrode,  thus  forming  a  rude,  though  effective,  controller. 
It  should  always  be  remembered,  however,  that  when  even  the  carpet 
is  thus  put  into  one  of  the  circuits  from  prime  conductor  to  patient 
that  we  get  a  condenser  effect,  due  to  charging  the  room,  and  this 
is  accentuated  when  we  charge  metal  masses  in  its  walls.  The  best 
method  of  reducing  the  strength  of  a  spark  application  to  suit  a  timid 
or  weak  patient  is  to  have  the  machine  turned  very  slowly  and  press 
the  ball-electrode  close  to  the  skin,  the  sparks  being  then  only  of  a 
length  equal  to  the  thickness  of  the  clothing. 

It  should  be  stated  here  that  the  Leyden  jars,  or  condensers,  are 
very  rarely  to  be  used  in  the  spark  applications,  and  never  any  other 
than  the  smaller  one  when  employing  miachines  of  many  plates,  as 
the  effect  on  any  part  of  the  body  not  profoundly  anesthetic  is  terrific. 
They  are  not  to  be  used  at  any  time  during  a  spray  application. 
When  not  used  in  the  shunt-controller  application  of  the  Morton 
static  induced  currents  they  are  best  out  of  the  way  on  top  of  the 
machine-case. 

Before  taking  any  spray  treatment  about  the  head  ladies  should 
invariably  remove  any  metallic  articles,  such  as  hair-pins,  etc.,  as 
otherwise  the  spray  effect  is  spoiled  by  slight  sparking  between  these 
objects  and  the  scalp.  They  should  also  remove  the  corsets  and  re- 
place the  outer  garments,  or  else  don  a  woolen  sac,  before  taking  a 
spark  or  spray  application  to  the  body. 

Clothing  formed  of  good  dielectric  material,  such  as  wool  and 
silk,  intensify  the  effects. 

(a.)  TJie  Static  Charge. — The  patient  is  seated  in  a  cane-bot- 
tomed chair  placed  on  the  insulated  platform  and  holds  in  the  bare 
hand  a  chain  or  rod  connected  with  the  pole  selected,  the  rods  having 
been  widely  separated.  From  the  other  pole  a  chain  is  carried  to  a 
neighboring  gas-fixture  or  watej-pipe,  in  order  that  the  whole  room 
may  receive  the  charge  from  this  pole.  When  the  machine  is  put  in 
operation  the  patient  will  be  highly  charged  with  the  polarity  with 
which  she  is  connected  by  the  chain  in  her  hand,  the  effects  being 
greater  if  she  be  connected  with  the  positive  pole.     A  good  speed 


FRANKLINIC,    OB    STATIC,    ELECTRICITY.  339 

of  the  machine  is  required.  The  current  escapes  from  the  patient 
at  all  points  and  angles,  the  charge  being  maintained  by  rapid  revolu- 
tion of  the  plates.  A  peculiar  sensation  is  produced,  and  in  many 
persons  free  perspiration  results.  Considerable  emphasis  is  laid  upon 
the  physiologic  and  therapeutic  effects  of  this  application  by  some 
writers.    It  is  distinctly  sedative. 

(6)  The  Electric  Spray. — With  the  patient  in  the  position  just 
described  and  holding  the  chain  attached  to  the  positive  pole,  an 
electrode  having  one  or  more  sharp  points  is  connected  with  the 
negative  rod  and  held  at  a  distance  of  from  six  inches  to  a  foot  from 
various  parts  of  the  body-surface,  whether  covered  with  clothing  or 
not.  The  point  is  electrified  negatively  and  communicates  its  charge 
to  the  adjacent  air-particles;  the  latter  are  attracted  to  the  nearest 
portion  of  the  body-surface,  giving  rise  to  a  discharge  by  convection, 
in  the  shape  of  a  continuous,  slightly-luminous  spray  of  electrified  air. 
If  the  current  is  weak,  there  is  a  distinctly  cooling  sensation,  the 
effects  of  the  actual  wind  predominating;  but  a  really-effective  spray 
soon  produces  a  pricking  and  feebly-burning  sensation,  particularly 
at  the  roots  of  the  hair  and  other  points  of  special  discharge.  The 
application  may  be  carried  over  all  parts  of  the  body,  or  may  be 
localized  at  a  painful  spot  for  some  minutes  by  attaching  the  point 
of  a  Cleaves  combination  stand  resting  on  a  glass  or  rubber  plate 
placed  on  the  floor. 

The  spray  is  weaker  when  the  active  electrode  is  connected  with 
the  positive  pole. 

The  head-spray  (Plate  XXII),  which  is  extremely  useful  in  all 
conditions  of  cerebrasthenia,  is  given  in  the  same  way,  a  head-piece 
bearing  many  points  being  connected  with  the  negative  pole  and  sus- 
pended about  six  inches  above  the  head.  This  method  is  a  general 
tonic  and  cerebro-spinal  derivative,  and  is  useful  in  conditions  of 
nervous  prostration,  insomnia,  hysteria,  and  neuralgias  of  mild  degree. 
It  should  precede  the  more  vigorous  treatment  by  sparks  in  very 
nervous  persons.  An  intermediate  method  between  the  spray  and 
sparks  is  obtained  by  using  a  wooden  electrode,  which  permits  a  more 
vigorous  spray  to  be  directed  against  a  part. 

(c)  SpavTcs. — With  the  insulated  patient  holding  a  chain  in  the 
bare  hand  attached  to  one  pole,  a  roller  electrode  is  attached  to  the 
other  pole  by  means  of  a  chain  and  is  passed  swiftly  over  the  surface 
of  the  woolen  or  silk  clothing  (Plate  XXIII).    The  sparks  that  pass  are 


340  DISEASES    OF    WOMEN. 

but  the  thickness  of  the  clothing  in  length  and  are  very  numerous. 
With  an  efficient  machine  this  form  of  sparks  is  usually  too  strong 
for  most  persons,  and  it  may  be  further  tempered  for  sensitive  cases 
by  interposing  the  resistance  of  the  floor,  a  third  chain  or  rod  passing 
from  the  operator's  pole  to  the  floor  on  which  the  end  of  the  chain 
attached  to  the  electrode  also  rests  at  some  distance  (Plate  XXIV).  To 
increase  the  effect  of  the  sparks  the  electrode  is  held  at  the  distance 
of  an  inch  or  more  from  the  clothing.  The  nature  of  the  puter  cloth- 
ing exerts  an  influence  over  all  forms  of  these  applications,  a  moist 
surface,  or  a  cotton  or  linen  one,  taking  the  current  to  itself  rather 
than  permitting  a  proper  penetration  to  the  body.  A  good  insulat- 
ing outer  garb  is  essential,  preferably  of  rough  woolen  material. 

The  mild  sparks  are  a  general  stimulating  tonic,  and  specially 
useful  in  the  backache  of  nervous  persons,  the  severe  sparks  being 
useful  also  in  anesthetic  conditions.  The  Leyden-jar  condensers  are 
not  used  except  in  profound  anesthesia. 

(d)  The  Franklinic  Induced  Current. — Dr.  Morton,  of  New  York, 
has  introduced  a  method  of  making  percutaneous  or  permucous  ap- 
plications of  what  is  known  as  the  franklinic  induced  current  in 
which  both  electrodes  are  applied  to  the  body  with  moist  coverings, 
as  in  faradic  or  galvanic  currents.  It  should,  of  course,  be  under- 
stood that  a  sparking  space  must  exist  somewhere  in  the  circuit,  and 
in  this  case  it  is  in  the  metallic  circuit  rather  than  at  the  surface  of 
the  body.  Very  short  sparks  only  are  bearable,  in  the  neighborhood 
of  a  line  in  length.  Better  results  are  obtained  if  the  condensers  are 
used,  giving  additional  amperage. 

Fig.  113  shows  the  connections,  the  smallest-sized  Leyden  jar 
being  usually  employed  and  the  electrodes  are  put  in  position  with 
the  rods  touching  before  the  machine  is  started,  the  right-hand  rod 
being  then  screwed  apart  slightly  from  its  fellow.  The  pressure  of  the 
current  is  determined  by  the  distance  between  the  balls.  This  cur- 
rent is  an  alternating  one,  reciprocal  sparks  passing  through  the  pa- 
tient between  the  external  coatings  of  the  condensers  contempo- 
raneously with  the  sparks  between  the  balls.  It  is  said  to  be  more 
effective  at  times  than  the  faradic  current,  but  is  more  troublesome 
to  manage,  the  cords  and  electrode  handles  requiring  to  be  specially 
constructed  with  high  insulation.  A  better  control  may  be  exercised 
over  this  current  by  placing  the  patient  in  shunt  with  a  Cleaves  static 
controller. 


FRANKLINIC,    OR    STATIC,    ELECTRICITY. 


341 


(e)  Ozone  Administration. — The  passage  of  these  high-pressure 
currents  through  the  air  results  in  the  production  of  considerable 
quantities  of  ozone  from  the  aerial  oxygen,  easily  detected  by  the 
peculiar  odor  or  by  its  turning  paper  a  blue  color  that  has  been 
moistened  with  a  solution  of  potassium  iodide.  It  can  be  adminis- 
tered from  a  small  electrode  with  a  number  of  points  which  is  held 
a  few  inches  from  the  mouth  and  nostrils  of  the  patient,  who  is  seated 
on  the  insulating  platform  connected  with  the  opposite  pole. 

After  Using  the  Machine. — To  maintain  the  charge  all  chains 
should  be  removed  from  the  prime  conductors  immediately  after  use 
and  the  rods  left  separated. 

Therapeutic  Uses  in  Gynecology. — In  adaptability  to  the  needs 


-f- 


Fig.  113. — Arraiigement  of  circuit  for  Morton's  static  induced  current. 


of  the  gynecologist  the  static  current  depends  for  usefulness  on  his 
recognition  of  the  neural  relationships  of  many  affections  apparently 
arising  in  the  sexual  organs,  as  well  as  on  the  purely  neural  character 
of  much  of  his  work,  for  its  value  in  chronic  sciatica,  insomnia, 
chronic  rheumatism,  and  various  neuroses  is  very  great.  An  im- 
portant fact  first  noted  clearly  by  Apostoli  is  that  the  strong  spark 
treatment  enables  us  to  discriminate  between  hysteria  and  neuras- 
thenia. In  hysteria  the  patient  is  capable  of  receiving  a  truly  enor- 
mous voltage  in  the  shape  of  sparks,  with  but  little  sign  of  feeling 
them.  This  is  because  hysterical  analgesia  is  so  common  in  these 
cases,  and  it  may  be  noted  that  under  the  stronger  sparks  the  hys- 


342  DISEASES    OF    WOMEN. 

t€rical  cases  improve  until  finally  the  sparks  give  as  much  pain  as 
normally  produced.  In  neurasthenia  no  such  tolerance  of  the  spark 
treatment  is  ever  found,  this  form  of  application  being  usually  so 
stimulating  as  to  be  wisely  replaced  by  the  spray.  Among  the  cases 
favorably  affected  by  this  current  those  of  neurotic  backache  stand 
pre-eminent,  and,  in  fact,  some  form  of  static  treatment  may  well  be 
conjoined  with  pelvic  applications  of  other  currents  if  this  symptom 
be  prominent  in  connection  with  organic  pelvic  disease.  For  mere 
sedation  the  positive  charge  may  be  used.  For  neurasthenic  condi- 
tions the  positive  spray,  or  the  stronger  negative  spra}',  either  station- 
ary or  mobile,  followed  later  by  the  lightest,  shortest  sparks. 

When  a  patient  is  under  other  forms  of  treatment  for  hysteria 
or  neurasthenia  it  is  usually  necessary  to  suspend  applications  during 
the  menstrual  periods.  At  these  times  the  static  spray  or  static 
charge  may  be  substituted  with  advantage,  maintaining  the  treatment 
without  the  harmful  break  that  often  interferes  with  quick  results. 
That  no  disrobing  is  required  for  this  application  is  a  distinct  advan- 
tage at  this  time.  Menstrual  discomfort  is  lessened,  and  no  risk  of 
causing  an  undue  flow  is  encountered  as  might  be  the  case  with  the 
galvanic  current. 

The  treatment  of  menorrhalgia  of  the  neural  type  may  be  con- 
ducted, at  times,  entirely  with  the  static  currents,  the  negative  spray 
being  directed  to  the  lumbar  region,  with  the  patient  sitting  sidewise 
on  a  chair  placed  on  the  platform  and  grasping  a  chain  connected 
with  the  positive  pole.  The  spray  should  be  strong  enough  to  pro- 
duce distinct  stinging  sensations,  and  may  be  followed  by  light  sparks 
to  the  same  spot  and  to  the  hypogastric  region.  These  applications 
are  always  helpful  at  and  before  the  menstrual  periods  in  nervous 
women,  particularly  if  the  nervous  symptoms  present  at  these  times 
are  attended  by  scanty  flow. 

For  the  treatment  of  the  nervous  disorders  of  the  menopause, 
either  natural  or  when  artificially  produced  by  ovariotomy,  the  static 
methods  are  often  extremely  useful,  rendering  the  employment  of 
neurotic  and  sedative  medicines  unnecessary.  Both  the  head-spray 
and  general  sparks  may  be  used. 

Production  of  Roentgen  Rays  by  the  Static  Machine. — Eoentgen, 
or  X-,  rays  have  heretofore  been  most  largely  serviceable  in  the  surgery 
of  the  bones  and  of  missiles  imbedded  in  the  body,  the  fleshy  organs 
and  such  morbid  conditions  as  come  under  the  notice  of  the  gyne- 


FEANKLINICj    OE    STATIC,    ELECTKICITY. 


343 


cologist  casting  but  slight  shadows  on  the  fiuoroscope  and  photo- 
graphic plate.    Recent  reports  of  the  action  of  these  rays  on  the  skin 


w^mr 


Fig.   114. — Queen  self -regulating  x-ray  tube. 


have  added  an  element  of  possible  therapeutic  usefulness  to  their  con- 
sideration, however;  and,  in  view  of  the  fact  that  a  static  machine, 
such  as  is  indispensable  in  the  larger  work  of  the  neuro-gynecologist. 


344  DISEASES    OF    WOMEN. 

forms  also  an  excellent  means  of  exciting  a  Crookes  tube  for  this  work, 
a  few  remarks  are  added  on  this  method  of  producing  the  rays. 

The  only  instruments  needed  in  addition  to  the  static  machine 
are  the  tube,  a  stand  for  holding  it,  and  a  fluoroscope,  rendering  the 
outlay  quite  small  for  this  special  use  of  the  machine. 

Even  the  smaller  static  machines  will  excite  tubes  made  with 
an  appropriate  exhaustion,  but  the  best  results  are  obtained  from  the 
large  instruments,  preferably  one  with  from  six  to  ten  revolving  plates 
of  large  diameter.  The  tube,  which  should  be  of  the  "focus"  type, 
should  be  specially  suited  to  the  machine,  the  dimensions  and  char- 
acter of  the  machine  being  given  to  the  tube  manufacturer  before  it 
is  purchased. 

The  long,  doubly-insulated  terminals  of  the  focus-tube  are 
specially  useful  when  the  static  machine  is  employed  as  exciter.  In 
use  the  short  tube  attached  to  the  middle  of  the  bulb  is  gently,  but 
firmly,  clamped  in  the  stand  in  such  a  position  that  the  opposite  side 
of  the  bulb  is  toward  the  object  to  be  radiographed.  The  concave 
electrode  must  be  attached  to  the  cathode,  or  negative  pole,  of  the 
machine  by  a  light  wire  and  the  platinum  plate  to  the  anode.  In 
action  the  cathode  rays  proceed  from  the  concave  electrode  and  focus 
on  the  anode,  from  which  spot  they  issue  in  a  powerful  stream  and 
impinge  on  the  glass.  It  is  at  the  glass  surface  that  the  Eoentgen 
rays  become  separated  from  the  cathode  rays,  the  latter  not  penetrat- 
ing the  glass. 

The  method  of  making  connections  is  shown  in  Fig.  115.  It  is 
necessary  to  have  the  condensers  in  circuit  (and  a  size  of  condenser 
must  be  selected  to  suit  the  tube),  with  the  rods  well  separated  and 
a  spark-gap  somewhere  in  the  circuit;  this  is  easily  accomplished  by 
slipping  a  ring  on  one  rod-handle  to  give  a  short  spark;  or  a  neater 
arrangement  is  the  author's  spark-regulators,  which  are  attached  to 
the  hard-rubber  handles  near  the  brass  portion  of  the  rods.  One  wire 
is  attached  to  the  binding-post  on  the  regulator  and  the  other  to  the 
brass  parts  of  the  opposite  pole,  which  should  have  its  rod  well  drawn 
back.  The  wires  for  this  purpose  should  be  very  light,  to  avoid  too 
much  traction  on  the  tube. 

The  best  way  to  ascertain  which  pole  of  the  machine  is  the 
cathode  and  which  the  anode  (and  in  some  machines  they  are  liable 
to  change  from  time  to  time)  is  to  bring  the  discharging-rods  close 
together  and  start  the  machine;    the  resulting  spark  will  be  bright 


FKANKLINIC,    OR    STATIC,    ELECTKICITY. 


345 


and  solid  next  to  the  anode  and  bluish  next  the  cathode.  If  a  mis- 
take is  made  and  the  tube  is  connected  wrong  a  ring  of  light  appears 
at  its  equator  and  no  lighting  up  of  the  fluoroscope  will  occur. 


Fig.   115. — Arrangement  of  static  machine  for  the  production  of 
Roentgen  rays. 


The  machine  should  be  run  at  full  speed  for  the  production  of 
Roentgen  rays. 

It  is  well  settled  that  the  dermatitis  that  follows  x-ray  exposure 
at  times  is  extremely  unlikely  to  be  encountered  when  the  rays  are 
produced  by  the  static  machine  instead  of  the  usual  coil. 


CHAPTER  XXVII. 

The  Sinusoidal  and   Incandescent  Alternating  Currents. 

The  Sinusoidal  Current. — For  a  number  of  years  the  author  has 
been  aware  that  the  successful  production  of  muscular  stimulation 


Fig.  116. — The  Kellogg  sinusoidal  apparatus. 


with  a  minimum  of  pain  was  largely  dependent  on  the  smoothness 
and  clearness  of  the  note  produced  by  a  good  interrupter  of  a  faradic 
apparatus;   that  "raggedness"  or  irregularity  of  these  very  imperfect 
(346) 


SINUSOIDAL    AND    INCANDESCENT    CURRENTS. 


347 


Fig.  117. — Graphic  representation  of  the  sinusoidal  current  ol  Dr.  Kellogg's 
apparatus.     ( Kellogg. ) 


Fig.  118. — Sinusoidal  curve  obtained  by  d'Arsonval. 


Fig.    119. — Current  from   faradic  apparatus    (Mcintosh).     A,  make; 
B,  break.     (Kellogg.) 


Fig.  120. — A,  current  from  faradic  apparatus  (Mcintosh),  same  as  Fig.  114, 

but  with  diflferent  adjustment  of  the  rheotome;     B,  current 

reversed.     ( Kellogg. ) 


348 


DISEASES    OF    WOMEN. 


Fig.  121. — Representation  of  magneto-electric  current  not  sinusoidal 
in  character.     (Keilogg.) 


Fig.   122. — Current  from  du  Bois-Reymond  coil. 
B,  break.     (Kellogg.) 


A,  make; 


Fig.    123. — ( Jiiaracteristic  marking  of  the   rapidly-successive  inductions  of 

a  poor   faradic   coil.     The   time-markings   indicate   V2go 

second  each.     (Kellogg.) 


V.  /vTAryxA/W^  VW^^AAAAAA/ '-  '^  ^^^  ^'  ^  ^ 


\  »  \  N  \  '  \ 


\  ^  »  \  »  \  <  M 


\  <   \   M  \   \  »  »   ^   \  »   \   \    M   1  \  \   M  \   \   \   n 


Fig.  124. — A,  current  from  coil  excited  by  Thompson-Houston  arc  light, 
alternating  10,800  times  per  minute;  B,  current  from  secondary  coil  of 
ordinary  faradic  apparatus  excited  by  alternating  current.  Time-markings 
represent  intervals  of  'Aso  second.     (Kellogg.) 


SINUSOIDAL    AND    INCANDESCENT    CURRENTS. 


349 


means  of  interrupting  tlie  inducing  current  produced  induced  cur- 
rents that  were  of  limited  contraction-usefulness  on  account  of  the 
pain  produced.  While  on  a  visit  to  Dr.  J.  H.  Kellogg  in  the  summer 
of  1887  he  was  surprised  to  find  a  magneto-electric  machine  in  use 
in  his  operating-room  which  produced  vigorous  contractions  with  but 
slight  sensation  (Fig.  116).  The  exact  reason  for  this  was  not  known 
until  the  researches  of  Professor  d'Arsonval,  of  Paris,  several  years 
later,  on  the  graphic  delineation  of  the  curves  of  induced  currents, 
showed  that  a  curve  of  smooth  and  uniform  rise  of  potential  pro- 
duced painless  contraction,  while  irregular  rises  and  falls  of  potential 


Fif.   125. — Mcintosh  sinusoidal  apparatus,  with  motor. 


were  painful.  By  means  of  an  electrograph  the  curves  of  current- 
variation  may  be  readily  recorded  on  a  revolving  cylinder,  the  accom- 
panying figures  (117  and  118)  representing  the  curves  thus  obtained 
by  d'Arsonval  and  from  Dr.  Kellogg's  apparatus.  The  curves  shown 
in  Figs.  119  to  124  are  in  marked  contrast  to  these,  showing  the 
ragged  character  of  the  irregular  rises  and  falls  of  potential  and  ex- 
plaining the  pain-producing  character  of  all  faradic  currents  of  any 
considerable  volume. 

The  sinusoidal  current  has  a  smooth  and  gradual  variation,  con- 
sisting of  both  an  equal  rise  of  potential  above  and  fall  below  the 


350  DISEASES    OF    WOMEN. 

zero-line.  This  latter  ciirTe  of  variation  represents  the  highest  and 
most  painless  efficiency  in  muscle-stimulation  with  slight  amperage, 
the  contraction  being  proportional,  of  course,  to  the  three  elements 
of  volts  of  rise,  suddenness  of  rise,  and  milliamperage  of  current. 
It  is  thus  seen  that  the  sinusoidal  current  is  typically  adapted 


Fig.  126. — Kennelly  sinusoidal  apparatus  and  motor. 

for  muscular  stimulation,  for  by  properly  constructed  apparatus  we 
may  apply  a  far  greater  milliamperage  for  this  purpose  than  the  pain- 
producing  qualities  of  the  primary  faradic  current  will  permit.  The 
exact  milliamperage  of  these  currents  is  yet  undetermined,  depending 
on  the  current  circulating  around  the  field-magnets  of  the  alternator, 
but  that  it  is  usually  intermediate  between  the  galvanic  and  faradic 


SINUSOIDAL    AND    INCANDESCENT    CURRENTS. 


351 


is  shown  by  the  fact  that  they  will  readily  stimulate  the  special  senses 
of  sight  and  taste. 

The  ease  with  which  a  large  number  of  complete  alternations 
per  second  of  this  smooth  character  can  be  obtained  adapt  the  sinu- 
soidal current  also  as  a  nerve-sedative. 

Sinusoidal  currents  are   produced  by  little   alternating-current 


Fig.   127. — Shaw's  acid  carbon  cell,  of  large  size,  for  running  motors, 
lighting  small  lamps,  etc. 


dynamos,  with  either  permanent  magnets  or  electro-magnets,  which 
are  operated  by  any  convenient  source  of  power,  an  electric  motor 
being  the  best.  The  patient  is  placed  in  a  shunt  circuit  with  a  Massey 
controller,  which  is  operated  in  a  reverse  manner, — that  is,  the  lever 
is  placed  all  the  way  around  on  the  nickel-plated  base  of  the  graphite 
area  at  the  start,  when  all  the  current  goes  through  the  instrument 
instead  of  the  patient;  by  turning  the  current  off  the  controller 
gradually  it  will  increase  through  the  patient's  circuit  with  equal  step. 


352  DISEASES    OF    WOMEN. 

The  only  drawback  to  this  instrument  as  compared  with  faradic 
apparatus  is  its  bulkiness  and  the  fact  that  from  two  to  four  large 
acid-carbon  motor  cells  must  be  used  to  operate  it  and  the  motor, 
or  four  times  as  many  Edison-Laland  cells,  in  the  absence  of  the 
more  convenient  street-current. 

The  Incandescent  Alternating  Current. — This  current,  which  is 
very  largely  used  at  present  as  an  illuminant  of  houses  and  offices, 
is  obtained  from  step-down  transformers  placed  on  the  exterior  of 
the  house,  by  means  of  which  the  high  voltage  of  the  street-mains 
is  reduced  to  either  50  or  104  volts,  according  to  the  transformer 
used  and  the  lamps  supplied.  It  may  be  employed  in  medical  applica- 
tions in  place  of  the  faradic,  but,  not  being  truly  sinusoidal  in  char- 
acter, is  generally  painful  even  when  greatly  reduced.  The  author's 
current-controller  forms  an  efficient  means  for  its  control,  when 
protected  by  a  small  fuse,  the  instrument  being  simply  intercalated 
between  one  wire  from  a  lamp-socket  and  the  patient,  the  other  wire 
from  the  lamp-socket  going  direct  to  the  patient.  As  already  said, 
this  current  is  distinctly  faradic  in  character  and  incapable  of  lasting 
electrolysis  or  cataphoresis.  It  can,  in  no  sense,  be  employed  as  a 
galvanic  current,  therefore,  in  spite  of  the  similar  heat-  and  light- 
producing  effects  in  the  large  amperage  traversing  the  filament  of  the 
lamp. 

There  is,  at  least,  one  emergency  in  which  its  modern  ubiquity 
may  make  it  of  service  in  saving  life, — namely,  in  post-partum  hemor- 
rhage in  a  house  supplied  with  this  current  and  where  a  battery  is 
not  to  be  had.  The  cord  of  a  drop-light  could  be  unwound  and  one 
wire  applied  by  coiling  it  in  a  wet  pad  to  be  placed  on  the  back,  while 
the  other  is  dipped  in  a  dish  of  water;  a  third  wire  from  the  opposite 
side  of  the  dish  of  water  going  to  a  pad  on  the  abdomen.  "Wlien  the 
wires  in  the  water  are  brought  closer  or  when  a  little  table-salt  is 
dropped  into  it,  a  means  of  gradually  increasing  the  current  to  the 
point  of  tolerance  is  thus  readily  produced,  with  powerful  contracting 
effects  on  the  relaxed  uterus. 


CHAPTEK  XXVIII. 

Electric  Light  as  an  Illuminant  and  as  a  Theeapeutic  Agent 

Direct  Illumination  of  the  Vagina. — Various  methods  have  been 
devised  for  illuminating  the  vagina  through  the  speculum  by  both 
reflected  light  and  direct  light  produced  by  incandescent  lamps.     As 


Fig.  128. — Sajous's  lamp-holder  and  stand. 


a  source  of  light  to  be  reflected  from  a  mirror  there  is  no  special 
advantage  in  the  incandescent  light  where  a  Welsbach  burner  or  ace- 
tylene-light is  obtainable;  in  fact,  it  is  inferior  to  either  of  these, 
though  at  times  more  convenient  on  account  of  its  readier  movability. 
Either  a  16-,  32-,  or  50-candle  lamp  is  essential  if  the  light  is  to  be 

"  (353) 


354 


DISEASES    OF    WOMEN. 


reflected  by  a  head-mirror,  and  the  use  of  these  lamps,  of  course, 
necessitates  the  taking  of  current  from  street-mains,  as  any  kind  of 
primary  or  secondary  batteries  of  the  voltage  required  would  be  both 
too  troublesome  and  too  expensive  in  maintenance.  The  light  may  be 
fixed  on  a  holder  or  held  by  a  second  person.  Of  portable  electric 
lights  Sajous's  lamp-holder  and  stand  is  shown  in  Fig.  128,  but  there 
is  a  mistake  evident  in  the  attachment  of  so  small  a  portable  battery, 
or  any  portable  battery,  to  a  lamp  described  as  having  a  resistance  of 
sixty  ohms,  which  is  intended  for  a  current  of  at  least  fifty  volts. 
Sajous  also  describes^  the  search-light  of  C.  W.  Isaac,  of  London  (Fig, 
129),  consisting  of  a  lamp  mounted  on  a  movable  base  of  hard  rubber 
within  a  tube  in  which  it  slides,  in  the  front  portion  of  which  is  set 
a  parabolic  mirror  so  adjusted  that  the  arch  of  the  filament  is  as 
near  as  possible  coincident  with  its  focal  point.     The  mouth  of  the 


Fig.  129. — Isaac's  search-light. 

reflector  is  closed  by  a  small  glass  cover,  which  protects  the  lamp  and 
prevents  the  silver  from  being  quickly  tarnished.  A  mirror  arranged 
in  this  way  would  doubtless  be  an  improvement  on  Phillips's  head- 
lamp or  if  placed  behind  the  filament  of  a  50-candle  lamp  on  the 
Sajous  stand  would  be  better  than  the  Tobold  condenser  shown. 
As  imported,  this  lamp  is  intended  for  a  smaller  lamp  supplied  by  a 
battery. 

Owing  to  the  interference  of  the  knees  and  the  general  position 
of  the  patient  during  a  gynecic  examination,  the  use  of  the  head- 
mirror  and  reflected  light  is  more  inconvenient  than  is  the  case  in 
other  medical  work,  and  better  illumination  is  accomplished  by  the 


'"International  System  of  Electro-Therapeutics,"  page  1-6.     Philadelphia: 
The  F.  A.  Davis  Co. 


ELECTRIC    LIGUT    AS    ILLUMINANT    AND    IN    THERAPEUTICS. 


355 


use  of  miniature  lamps  carried  on  a  head-piece  in  such  a  way  that  the 
Hght  projects  between  the  eyes  in  a  line  with  the  line  of  vision. 
These  small  lamps  have  the  added  advantage  that  they  may  be  sup- 
plied with  current  from  a  few  large  acid  motor  cells  in  the  office  or 
portable  storage  cells  of  a  few  volts  elsewhere.  The  best  of  this  kind 
of  apparatus  is  that  devised  by  Dr.  W.  C.  Phillips,  of  New  York  (Fig. 
130).  This  is  light  of  weight,  easy  of  adjustment,  and  has  a  good 
lens.  The  instrument  consists  of  a  narrow,  but  strong,  steel  band, 
similar  to  Fox's,  lined  throughout  with  fibre.  Attached  by  a  rotary- 
motion  joint  is  a  small  condenser  which  carries  a  4-candle-power  lamp 
of  four  or  six  volts.     By  means  of  a  thumb-screw  at  the  side  of  the 


Fig.  130. — Phillips's  electric  head-light  foi"  four-  or  six-  volt  lamp. 


condenser  the  focus  may  be  easily  and  quickly  regulated  without  re- 
moving the  lamp  from  the  head.  To  furnish  the  current  for  this 
lamp  in  office-work  the  best  generator  is  the  Shaw  acid-carbon  cell 
(Fig.  127),  two  of  which  should  be  coupled  up  in  series  for  4-volt 
lamps  and  three  for  6-volt  lamps.  In  case  a  German-silver-wire  con- 
troller or  rheostat  is  used  with  these  cells,  an  additional  cell  will  add 
to  the  length  of  time  that  the  fluid  can  be  used.  The  fluid  requires 
to  be  renewed  quite  often.  The  storage  battery  is  more  expensive, 
but  more  convenient,  if  an  Edison  circuit  is  convenient  for  charging, 
but  in  the  absence  of  this  facility  the  storage  battery  is  a  nuisance, 
except  as  an  expensive  means  to  obtain  a  portable  light. 

Small  lamps  mounted  on  slender  holders  may  be  held  in  the 


350  DISEASES    OF    WOMEN. 

speculum  for  examination,  but  are  in  the  way  in  case  manipulations 
are  necessary. 

Transillumination  of  the  Pelvis. — The  fact  that  limited  thick- 
nesses of  the  body,  such  as  the  finger  and  part  of  the  palm,  may 
readily  become  translucent  to  the  rays  of  even  a  moderately  strong 
light  seems  to  have  been  lost  sight  of  as  a  means  of  diagnosis  until  the 
laryngologists  took  it  up  in  1888,  when  Cozzolino,  of  Naples,  fol- 
lowed by  Voltolini,  of  Breslau,  illuminated  the  walls  of  the  nose  and 
accessory  cavities  and  the  larynx;  the  former  by  miniature  lamps 
within  the  closed  nostril  or  mouth,  and  the  latter  by  a  lamp  on  the 
outside  of  the  neck,  covered  by  an  obturator,  the  light  being  per- 
ceived by  the  use  of  a  laryngoscopic  mirror  within  the  dark  pharynx. 

The  application  of  the  principles  thus  disclosed  to  gynecology 
has  been  retarded  by  the  greater  thickness  of  the  body  in  this  situa- 


Fig.    131." — Author's  pelvic  transilluminator. 

tion,  rendering  the  miniature  lamps  that  are  capable  of  being  intro- 
duced ineffective  as  a  source  of  light.  I  have,  however,  myself  suc- 
ceeded in  illuminating  the  abdomens  of  moderately  thin  women  by 
the  lamp  devised  by  me  (Fig.  131),  which  consists  of  a  6-  or  8-volt 
lamp  mounted  on  a  holder  in  front  of  a  plane  reflector,  and  the  whole 
inclosed  within  two  test-tubes  separated  by  rubber  bands.  The  special 
advantage  of  this  arrangement  is  the  two  air-spaces  separated  by  the 
test-tubes,  reducing  the  radiation  of  heat  and  permitting  ready  cleans- 
ing. The  abdomen  is  illuminated  by  a  reddish  glow  half-way  to  the 
navel.  This  light  is,  however,  insufficient  to  illuminate  the  tissues 
in  case  of  fat,  or  corpulent,  patients,  and,  as  the  value  of  the  procedure 
hinges  on  the  absence  of  transmission  as  an  evidence  of  pus  accumula- 
tions and  possibly  tumors  of  dense  consistence,  it  is  evident  that  a 
more  powerful  light  is  necessary.     This  may  be  obtainable  in  the 


ELECTRIC    LIGHT    AS    ILLUMINANT    AND    IN    THERAPEUTICS.  357. 

Jackson  apparatus  (Fig.  133),  though  I  have  not  tried  it,  which  em- 
ploys the  principle  discovered  by  Belin  in  1889,  that  a  glass  rod  will 
transmit  rays  of  light  to  its  extremity  without  heat  if  the  rod  is 
silvered,  the  rod  even  being  capable  of  being  bent  into  various  shapes. 
The  apparatus  is  of  two  parts, — an  electric  lamp  of  50-candle  power 
and  a  silvered  glass  rod.  The  lamp  is  inclosed  in  a  case  silvered 
within  and  blackened  without.  Projecting  from  the  side  of  the  case 
is  a  metal  neck  into  which  fits  a  perforated  asbestos  cork;  through 
the  cork  passes  the  glass  rod,  which  is  also  silvered  over  except  at 
the  ends,  the  silvering  being  protected  by  varnish.    The  brilliant  light 


Fig.    132. — Apparatus   of  Chevalier   Jackson  as  arranged   tor   trans- 
illumination of  the   nasal  passages  and  antrum. 


within  the  lamp-case  is  transmitted  axially  through  this  rod  and  issues 
from  the  distal  end  with  undiminished  brilliancy.  The  rod  does  not 
get  hot,  and  should  be  slightly  warmed  before  insertion. 

Another  mode  of  obtaining  transillumination  of  the  pelvis  is  to 
place  a  32-  or  SO-candle-power  lamp  over  the  abdomen  in  a  conical 
receiver  made  to  exclude  all  light  except  that  which  traverses  the 
skin  and  abdominal  walls;  if  a  speculum  be  then  placed  in  the  vagina 
the  tissues  will  be  seen  to  shine  with  a  red  glow. 

All  work  in  transillumination  should  be  done  in  a  thoroughly 
darkened  room. 


358 


DISEASES    OF    WOMEN. 


The  value  of  transillumination  is  limited  by  the  fact  that  all 
living  tissues  appear  nearly  the  same  in  color  and  shade.     It  is  im- 


s^r^M  r-fjiit^ 


Fig.   133. — Alteinating  cunent-tiaiisfonner  of  Williams,  Brown  &  Earlc. 

possible  to  make  out  the  anatomical  parts  except  the  large  veins  and 
the  bones,  and  these  only  by  a  darker  shading.     Accumulations  of 


f'ig.    I.'i4. — (.  oiUidllcr   l<ir   ligliling  small    lamps  and   heating  cautery- 
loops  from  Edison  current. 


pus  will  appear  as  a  dark  shadow,  wliile  cystic  tumors  are  lighter  than 
their  surroundings.  No  light  is  transmitted  if  there  be  extensive 
exudations,  and  dense  fibroids  and  possibly  cancerous  tumors  cast  a 


ELECTRIC    LIGHT    AS    ILLUMINANT    AND    IN    THERAPEUTICS. 


359 


shadow  or  interfere  with  transmission.  Hematomas  should  also  be 
opaque,  if  the  general  rule  holds  good  that  dead  tissue  is  opaque  to 
the  rays. 

With  a  satisfactory  source  of  light,  the  value  of  this  procedure 


in  diagnosis  is  evident. 


Electric  Light  as  a  Therapeutic  Agent.^ — The  therapeutic  use  of 


Fig.  135. — The  Kellogg  electric-light-bath  cabinet. 


electric  light  is  mainly  due  to  the  facility  with  which  an  application 
of  radiant  heat  may  be  made  to  the  whole  or  a  part  of  the  body.  A 
16-candle  light  inclosed  in  a  bell-shaped  shield  placed  over  a  painful 


'  For  Report  of  Standing  Committee  on  "Electric  Light  as  a  Diagnostic 
and  Therapeutic  Agent,"  see  the  Transactions  of  the  American  Electro-Thera- 
peutic Association,  page  295,  1894. 


360 


DISEASES    OF    WOMEN. 


spot  will  quickly  and  pleasantly  do  all  that  a  hot  application  can  do 
to  relieve  pain  and  possibly  more,  for  it  may  be  that  the  effect  is  due 
as  much  to  the  penetration  of  light  to  the  nerve  as  it  is  to  the  heat. 
Such  an  application  will  be  followed  by  a  circumscribed  redness,  and 
repeated  applications  will  tan  the  skin  like  sunlight.  Moist  heat — a 
radiant  poultice — may  be  applied  locally  by  wrapping  the  lamp  in 
wet  cloths  (leaving  the  base  of  the  lamp  unmoistened,  of  course). 

Dr.  J.  H.  Kellogg  has  detailed  a  series  of  experiments  on  the 
physiologic  effect  of  the  electric-light,  or  radiant-heat,  bath  in  a  paper 
before  the  Americal  Electro-Therapeutic  Association.^  He  employed 
a  cabinet  lined  with  mirrors  and  containing  sixty  incandescent  lamps, 
so  arranged  that  the  patient  lies  in  an  horizontal  position,  the  lights 
being  placed  on  three  sides  (Fig.  135).    The  patient  lies  on  a  suitable 


Fig.   136.- — The  electrotherm :    an  electric  heating  pad  for  replacing 
hot-water  bags  and  bottles. 


couch  with  rollers,  which  is  pushed  entirely  within  the  cabinet,  or 
only  so  far  as  to  expose  such  portions  of  the  body  as  it  is  desirable 
to  bring  under  the  influence  of  radiant  heat  and  light.  It  is  only 
necessary  to  protect,  by  a  sheet  and  piece  of  mackintosh,  any  portion 
of  the  body  which  it  is  desired  to  exclude  from  the  action  of  the  bath. 
The  results  of  his  investigation  showed  that  the  electric-light 
bath  was  superior  to  either  the  Turkish  or  Eussian  baths  in  stimu- 
lating vicarious  elimination  by  the  skin,  the  amount  of  perspiration 
induced  being  fully  double  that  induced  by  the  Turkish  bath  in  the 
same  time. 


1894. 


'  Transactions  of  the  American  Electro-Therapeutic  Association,  page  153 


ELECTRIC    LIGHT    AS    ILLUMINANT    AND    IN    THERAPEUTICS.  361 

The  electrotherm,  or  electric  hot  pad  (Fig.  136),  is  an  excellent 
substitute  for  a  hot-water  bag  for  local  applications  of  heat  to  the 
body,  the  special  advantage  of  the  instrument  being  the  maintenance 
of  the  desired  heat  for  any  length  of  time  required,  in  which  it  is 
incomparably  superior  to  hot-water  bags. 


APPENDIX  A. 

TABLE  OF  EIGHTY-SIX  COXSECrTITE  CASES  OF  FrBEO:SIATA, 

WITH  DETAILS  OF  TEEATiVIEXT  AXD 

ULTEVIATE  EESULTS. 


(363) 


364 


DISEASES    OF    WOMEN. 


•aaiJiH3A  ai^AV 

snasaa  x'-ttJA 

iN3KiyaHx  ao  koix 

-rssao  Haiay  skix 

ca 

O 

:o 

OS 

Sympt.      cure     and 
early    reduction    of 
size  one-third.     Re- 
cent   report  of    pa- 
tient   says    growth 
has  disappeared. 

Temporary   aggra\a- 
tion  of  pain  diw  to 
freiiiiency  of   treat- 
ment ;     subsequent 
improvement. 

Septicemia   occurred 
during  expulsion  of 
tumor,  followed  by 
death  on  the  twelfth 
day. 

Kelief  of  symptoms; 
reduction  of  tun:or 
to  a  nodule  and  of 
uterus     to     normal 
size. 

fez 

§^ 

a 

Buried  puncture,  — , 
GO   to    200   ma.   at 
intervals  of  a  week, 
followed    by   intra- 
uterine. 

Intra-uterine,  100  to 
200  ma. ,  eight  times, 
daily. 

Intra-uterine,  —  and 
+,  25  to   ;?00    ma. 
every  other  day  un- 
til  OS    dilated    and 
tumor  presented. 

Intra-uterine,  — and 
4-.  40  to  150  ma.; 
ten  applications. 

Clinical  Symptoms. 

Pressure  on  bladder 
and  menorrhagia. 

General    pressure 
symptoms  and  im- 
pairment of  health. 

Bloody   and    watery 
discharge,  pain,  and 
general  impairment 
of  health. 

Pain    and    purulent 
leucorrhea. 

Description  of 
Growth. 

Interstitial    growth, 
size    of    cocoa-nut, 
projecting  into  right 
broad  ligament. 

Intei-stitial  and  sub- 
peritoneal      multi- 
nodular growth  fill- 
ing   abdomen   to  4 
inches  al)ove  umbil- 
icus. 

Sul)mucous,      sessile 
fibrocyst,   enlarging 
uterus     symmetric- 
ally  to   size   of 
seventh    month    of 
pregnancy. 

Sul)mucous       sessile 
polyp  of  small  size  ; 
u  t  e  r  u  s    liypertro- 
phied  ;   cavity   four 
inches. 

Known 
Dura- 
tion OF 
Growth. 

4  years. 
20  years. 

5  years. 
2  years. 

'iNaixvj  JO  soy 

2                     1  SS 

^                       1  cs 

Referred  By 

OUTlJEATKD 
AT 

Dr.  H.  A. 
Kelly,  Balti- 
more. 

Dr.  T.  Hew- 
son  Bradford, 
Philadelphia. 

1 

1     •asvf)  .ao  •OK 

r^ 

(N 

CO 

•V 

APPENDIX    A. 


365 


t 

00 

1 

1 

00 

1 

i 

CO 

Sympt.  cure;  patient 
reports     disappear- 
ance. 

Patient  reports  dis- 
appearance.      The 
discharge      quickly 
cured. 

Disappearance  of  tu- 
mor and  of  all  symp- 
toms, and  reduction 
of  uterus  to  normal 
size.     Bands  of  atl- 
hesion  left. 

Quick     release     uj)- 
ward  into  abdomen, 
with     improvement 
of     health  ;     subse- 
quent reduction  to 
two    inches    below 
navel  ( one-third ) . 

Sympt.     relief     and 
considerable  shrink- 
age. 

Intra-uterine,  +  and 
— ,   65  to   150   ma. 
at  intervals  of  week 
or  more. 

Intra-uterine,   60  to 
200    ma.    —    twice 
weekly.    Later  once 
weekly. 

Intra-uterine,  — ,  50 
to  150  ma.  twice  a 
week. 

Intra-uterine,  80  to 
250    ma.   —    every 
other  day.      Later, 
every  fourth  day. 

Intra-uterine,   50  to 
125    ma.    —    twice 
weekly,  with  inter- 
vals of  non-attend- 
ance. 

Profuse  and  hastened 
periods,  severe  pain, 
and    difficult    loco- 
motion. 

Constant    pain,    ag- 
gravated at  periods, 
which    were    of    2- 
week  type,  and  pro- 
fuse,   offensive,  pu- 
rulent leucorrhea. 

Constant  pain  in  left 
groin  and  on  walk- 
ing,   with    profuse, 
purulent        leucor- 
rhea. 

Severe  pain,  inflam- 
matory   attacks, 
pressure  symptoms, 
and  impairment  of 
health. 

Pain  and  other  press- 
ure symptoms,  with 
menorrhagia       and 
profuse        purulent 
leucorrhea. 

Intramural,      multi- 
nodular growth,  fill- 
ing   abdomen    and 
extending    two 
inches  above  navel. 

Subperitoneal       and 
intramural     multi- 
notlular  growth,  ex- 
tremely hard,  filling 
pelvis     and     lower 
third  of  abdomen. 

Intramural      gi'owth 
filling    pelvis,   with 
subperitoneal     pro- 
jection   re  aching- 
crest  of  the  ilium. 

Intramural  symmet- 
ric fibroid  of  large 
size,      wedged      in 
pelvis   and   extend- 
ing to  the  navel. 

Intramural  nodule,  2 
inches  in  diameter, 
in  posterior  wall  of 
retroflexed  uterus. 

12  years. 

9  mos. 
\\  years. 

1  year. 

?§ 

CO 

O                 1  <M 

Dr.  T.  Hew- 
son  Bradford, 
Philadelphia. 

Dr.  F.  Wood- 
bury, Phila- 
delphia. 

Dr.  Bradford, 
Philadelpliia. 

Dr.  William 
Pepper,  Phil- 
adelphia. 

It 
if  2 

\n 

«o 

i> 

00 

OS 

366 


DISEASES    OF    WOMEX. 


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APPENDIX    A. 


367 


4 

a 

o 

a 

1 

a 

CD 

8 

a 

Eelief  of  symptoms; 
no  record  of  change 
of  size. 

Arrest      of     hemor- 
rhage, restoration  of 
menses    to    28-day 
type,  and  slight  re- 
duction in  size. 

Relief  of  pain,  regu- 
lation  of    menstru- 
ation, and  consider- 
able   reduction    in 
size. 

Total    disappearance 
of   tumor.      Uterus 
normal     in     s  i  z  e. 
Menstriiation     nor- 
mal.      Hemorrhage 
arrested. 

1 

o 

■33^ 
o  o 

Intra-uterine,  — ,  35 
to  50  ma.  twice  a 
week. 

<u  aj    ■ 
a  o 

»— 1 

Buried  puncture,  — , 
200,     three     times, 
and     intra-uterine, 
+,  50  to  100  once  a 
week. 

Intra-uterine,   -f,  60 
to  110  ma.  twice  a 
week. 

Intra-uterine,         + 
and  — ,    30    to    70 
once  a  week. 

Irritable       bladder, 
pain  in   back,    and 
painful  locomotion. 

Severe    pain,    press- 
ure, profuse  hemor- 
rhage,  and    leucor- 
rhea.      Menstruates 
every  21  days. 

Hemorrhagic  periods 
and  constant  pain. 

Profuse   hemon-hage 
and  impairment  of 
health. 

Excessive        menor- 
rhalgia  and  antici- 
pated periods.  Very 
tender    in    hypo- 
gastrium. 

Interstitial,    size    of 
large  lemon,  in  an- 
terior wall.      Peri- 
metric adhesions. 

Interstitial     growth, 
size    of    lemon,    in 
posterior  wall  of  re- 
troflexed  uterus,  oc- 
cupying    Douglas's 
pouch. 

Interstitial      growth 
filling    pelvis. 
Uterus  retroverted. 
Syphilitic  history. 

Interstitial      growth 
filling    pelvis    and 
extending     above 
level  of  upper  spines 
of  ilium. 

Interstitial,    size    of 
an  orange,  in  ante- 
rior wall. 

05 

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1-1 

368 


DISEASES    OF    WOMEN. 


1KSKST3SX 

i 

S 

s 

z 
CS 

Nodule      in      iu'lvis 
smaller  and  Hatter. 
Pressure  symptoms 
lesseneil,       and 
bowels   move    more 
freely. 

No  sign  of  tumor  ex- 
cept lumps  ill  tubal 
region."   I'terus  nor- 
mal    in     si/e    and 
movable.     No  jiain. 
Periods  regular. 

Disappearance        o  f 
pain. 

Complete  disajipear- 
ance    of    i)rojeetion 
and  symptoms. 

S 

Puncture,    |-  and  — , 
.50   to   100  ma.,  six 
times. 

Intra-utcrine,  -\-,  (iO, 
followed  by  —  vag., 
10.     The  first  treat- 
nieiili    caused     pro- 
longed   hemorrhage 
and  ])ain. 

Iiitra-uterine,  -|-,  30, 
four  times. 

r 
|i 

aS 

1—1 

r                 =  "S  - 

J            ,     J.  a:  ^ 

2          1^4 

Hemorrhagic  periods 
21-day    tyjie,     with 
ineiiorrhalgia      and 
tenderness. 

Constant  hemorrhage 
and  pain.     Bladder 
irritjible. 

Pain,    fever,     irrit.a- 
bility    of     blathler, 
and  irregular  men- 
struation. 

O 

Hubperitoneal      nod- 
ular,   tilling    pelvis 
and    abdomen    and 
extending    to    rilts. 
Treatment  conlined 
to  noilule  in  Doug- 
las's |)oiieh. 

Intei-stitial     enlarge- 
ment of  fuiulus  to  a 
size  that  lilts  ])(dvis. 
Multinuelear,  lirmly 
adherent.       Cavity, 
3-^  inches. 

Interstitial,  globular, 
size  of  large  cixjoa- 
nut,      in     pasterior 
wall.       Cavity,      4 
inches. 

Interstitial,    size    of 
goose-egg,     in     left 
wall,   extending 
.above  level  of  true 
pelvis. 

Known 

TION    OF 

Uuowi'lt, 

14  years. 

>> 

-xmnxTj  JO  asT'     §                                  ]     m                             \     ^                        i     § 

Ik        -'-^ 

Hr<                       >    a- 

So                 = 

Howard  Hos- 
pital. 

Howard  Hos- 
pital. 

BE    . 

•s3 

o 

■asv.)  .ao  'OX 

- 

5( 

T< 

§J 

o 

m 

«a 

a 
a 


a 
< 


APPENDIX   A. 


369 


i 

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Intra-uterine,    |  ,  20 
to  80  ma.,  six  times. 

5S8 

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Hemorrhage  and 
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Inteistitial,    size    of 
cocoa-nut,    in  ante- 
rior wall,  extending 
to    upper    level    of 
ilium.      Cavity,  4^ 
inches. 

1  E.^  §c35' 

O    >    2.     - 

■-3  tf  "-=     - 

Interstitial     involve- 
ment    of      whole 
uterus,       inel  tiding 
cervix,  (illiiif^  pidvis 
and     exti'iidiiip,     to 
crest  of  iliiw,  hones, 

a  i£ 
a   r   .-i 

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known. 

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370 


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■aaijiaaAaa^M. 
gii.isaa  N'aHAV 

AO   XOIi,YSSA0 

i 

>» 

■"9" 

7  mos. 

Results. 

Reduction    of    solid 
part  of  tinnor  tosi/e 
of     orange  ;    sub.se- 
(jiieiit     increase     of 
cystic  portion.     Op- 
eration   advised, 
under  which  patient 
succumbed. 

Symptomatic        im- 
provement.   Tumor 
slightly  smaller  and 
moie      disengaged. 
Later  was  ojierated 
on.     Present  health 
poor. 

Relief    of    pain   and 
restoration   of    nor- 
mal flow  (5  days). 
Tumor       distinctly 
smaller. 

Relief  of  pain,  hemor- 
rhage,   and    leucor- 
rhea.    No  notes  of 
change  in  size. 

Method  of  Treat- 
ment. 

Intra-uterine,   j  and 
— ,  40  to  150  twice 
weekly,  changed  to 
abdomino-dor.siil  al- 
ternatives, 150  ma., 
after   3   mos.,  with 
aspiration  of  cysts. 

Intra-uterine,  -f ,  25 
to  70  once  a  week, 
with  intervals.  Vag- 
inal       aitplications 
for  a  time. 

Intra-uterine,   -4-,  20 
to  60  about  twice  a 
week.     Cramps  fol- 
lowed treatment. 

Intra-uterine,  -f  >  20 
to  30,  six  times,  with 
one  -{-  vag.  100. 

Clinical  Symptoms. 

;\ttacks    of     intense 
l)ain  at  periods,   in 
which  tumor  swells 
sevi-ral  times  largei-, 
in\pinging  on  ri))S  ; 
no         hemorrhage. 
Health  im))aire(l. 

Menstrual      flooding 
every  3  weeks,  witli 
constant    pain   and 
tenderness.    Menor- 
rbalgia. 

M«>nstrual  crami)s  re- 
(iniring      plij'sician 
and   morphia   regu- 
larly.     Flow    lasts 
two   weeks   and    is 
profuse. 

Constant      bleeding, 
lasting  for  months, 
re(|uiring     rest     in 
bed  ;  constant  pain 
a  11  d       tenderness  ; 
copious  leucorrhea. 

Description  of 
Growth. 

Interstitial     myoma 
extending   an    inch 
above  navel,  with  a 
cystic  projection  on 
right        contiiining 
"cells      of      Drys- 
dale." 

Intramural  and  sub- 
peritoneal     projec- 
tion     from      right 
cornu,   reaching    to 
1\      inches      below 
navel.     Cavity,     S-i 
inches. 

Interstitial    enlarge- 
ment     of      uterus, 
with  projections  to 
both    sides.      Elec- 
trode    inserted    3^ 
inches. 

Intramural    growth, 
size  of  large  lemon, 
in  left  wall. 

Known 
Dura- 
tion OF 
Growth. 

7  years. 

9  mos. 
12  years. 

■IKZIlVi  JO  30t|   ^ 

g 

1  '* 

I' 

xx< 
&■ ... 

^0 

Dr.  William 
Good.ll,  Phil- 
adelphia. 

Dr.  A.  W. 
Watson,  Phil- 
adelphia. 

Dr.  Wharton 
Sinkler,  Phil- 
adelphia. 

•asvf)  AO  "OM 

's 

i  e< 

'^ 

'  CO 

AIM'KNDIX    A. 


371 


6  years. 

1  year. 

i 

i 

i 

Cure  of  all  symptoms 
and     reduction     to 
small  nodule.    Res- 
toration   of    heallh 
I)erfect. 

Release     of      tumor 
from  pelvis  upward 
into  abdomen.    Re- 
sults otherwise  neg- 
ative. 

Nor  m  a  1       periods, 
great   improvement 
in  health,  and  slight 
reduction  in  size. 

Comxilete  disapi^ear- 
ance  of   tumor  and 
restoration     of 
health. 

Normal  periods,  free 
from  pain  at  4-\veek 
i liter \als,    with   re- 
lief of  weight  symp. 
and     reduction     of 
cavity  to  3  inches. 

Intra-uterine,  —  and 

4-,    20  to    70   ma.  ; 
later     intra-uterine 
alternatives,    70    to 
100     ma.     once     a 
week. 

Vagiuo-abd .  alterna- 
tives,  150  ma.,  with 
occasional        intra- 
uterine,  — ,    30    to 
100.     Puncture  im- 
possible,  owing    to 
bladder. 

Vagino-abd.  alterna- 
tives,  100  ma.  once 
a    week.       Intra- 
uterine     treatment 
not  well  borne. 

Buried  puncture,  — , 
100  to  150  ma.  every 
two  weeks. 

Intra-uterine,   -f ,  30 
to  (50  once  a  week,  at 
intervals. 

Former    attacks    of 
bleeding;        at 
present    pain     and 
pressure  symptoms. 

2  6 

5  S 

■*^   bfl 

6  aj 

a  o 

Bleeding  periods  and 
local  tenderness  as- 
sociated      with 
bronzed   skin,   ane- 
mia,   and     neuras- 
thenia. 

Retention    of    urine 
occurring    fre- 
quently     caused 
tumor    to    be    dis- 
covered.  Much  pain 
in  left  leg.     Menses 
free. 

Menorrhalgia       and 
menorrhagia    at    3- 
week  intervals. 
Constant   i^ain   and 
weight.    Leucor- 
rhea. 

Interstitial    enlarge- 
ment  of   uterus   to 
size  of  child's  head, 
extending       to       3 
inches  l)elow  navel. 

Subperitoneal 
growth,  filling  pel- 
vis   and   extending 
to     IJ     inches     of 
navel,    attached    by 
sessile     jiedicle     to 
fundus  of  uterus. 

Interstitial       multi- 
nodular       growth, 
size  adult  head,  ex- 
tending to  2  inches 
below  navel. 

Subperitoneal  sessile 
growth,     extending 
from        Douglas's 
pouch   to   2   inches 
below  navel.     Nar- 
row, movable. 

Intramural      jorojec- 
tion  size  of  walnut 
from  posterior  wall. 
Cavity,    30    inches. 
Enlarged   ovary  on 
right  side. 

2  years. 

aj 

Dis- 
covery 
recent. 

U3 

CD 

1     "5 

1   o 

CO 

Dr.  E.  L. 
Duer,  Phila- 
delphia. 

Dr.  Lnsk, 
Penn  Yan, 

N.  Y. 

Dr.  William 
Goodell,  Phil- 
adelphia. 

Dr.  T.  C. 
Davis,  Bridge- 
ton,  N.  J. 

^ 

1     fO 
CO 

1  •* 

1  " 

1  " 

1  % 

1    " 

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Relief   of    pain. 
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I'atieut  reports  that 
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375 


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DISEASES    OF    WOMEN. 


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Growth. 

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CO 

Referred  By 
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AT 

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pital. 

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09 

o 


APPENDIX    A. 


379 


No  ad- 
vice since 
treat- 
ment. 

6  mos. 

i 

43 

a 

'S 

^3 

a 

05 
05 

0^ 

Sj'mptomatic        im- 
provement  in   pain 
and       hemorrhage. 
Tumor  smaller. 

Disappearance        o  f 
hemorrhages,  limp, 
and      other     symp- 
toms, and  sonif  re- 
duction in  size. 

Disappearance         of 
tumor    and     symp- 
tomatic cure. 

Symptomatic      cure 
and       considerable 
reduction  in  size. 

Symptomatic  cure. 

Symptomatic       cure 
and  reduction  to  2 
inches  below  navel. 

Intra-uterine,  +,  25 
to  60  ma. 

Intra-uterine,   +,  50 
to  75,   flexible   cot- 
ton-covered       elec- 
trode    interspersed 
with  vag.  galv. 

Intra-uterine,  +,  50, 
and  vag.  galv. 

Intra-uterine,     zinc- 
amalgam     catapho- 
resis, 40  to  80  +. 

Intra-uterine,  -f,  35, 
flexible     electrode, 
on  six  occasions. 

Intra-uterine,       + , 
200,  sectional  elect. ; 
later   zinc-amalgam 
cataphoresis. 

Profuse      periods. 
Tumor  again  grow- 
ing after  operation 
for  tying  broad  liga- 
ments.       Adherent 
vag.  sinus. 

Hemorrhagic      peri- 
ods.    Lame  in  left 
leg    from    pressure. 
Health  depressed. 

Occasional      hemor- 
rhages, some  tender- 
ness,   and    impair- 
ment of  health. 

Hemorrhagic      peri- 
ods, tenderness,  and 
general  impairment 
of  health, 

u 
o 

05 

a 

a 
^^ 

Ph  '^ 

Frequent         hemor- 
rhages and   menor- 
rhagia,    with    pain, 
leucorrhea,  and  im- 
paired health. 

Interstitial       pelvic 
tumor  size  of  large 

fist. 

Interstitial       pelvic 
tumor    of     fundus, 
size  of  pullet's  egg. 
Cavity,  3  +,  retro- 
flexetl. 

Interstitial       pelvic 
tumor     of     fundus 
about   2   inches   in 
diameter,      project- 
ing into  Douglas's 
pouch. 

Interstitial    abdomi- 
nal    tumor     filling 
lower  abdomen  to  2 
inches  above  navel. 

Interstitial        pelvic 
tumor,  size  of  cocoa- 
nut.        Cavity,      4 
inches. 

Interstitial   abdomi- 
nal   tumor    size   of 
adult  head,    filling 
lower  half  of  abdo- 
men to  navel.    Cav- 
ity, 6^  inches. 

i 

1 

CO 

a  1 

a 

CO 

a 

05 

8 

i 

O                                  '     00 
CO                                       CO 

<5 

CO                      [CO                      1     U5 

Dr.  F.  H. 

Martin,  Chi- 
cago, 111. 

Howard  Hos- 
pital. 

Dr.  W.  S. 
Janney,  Phil- 
adelphia. 

Dr.  Thomas 

Drysdale, 
Philadelphia. 

?: 

B 

^ 

s         1 

^ 

g^ 

380 


DISEASES    OF    WOMEN. 


■aaijiH3Aaa3M. 
snnsHH  ic3Hav 

AO  Nouvssao 
aaxjv  awij. 

1— 1 

Results. 

Unknown.       Tumor 
sul)se(iuently        re- 
moved  by  Dr.  Ha- 
mill. 

Symptomatic     cure. 
No      record     of 
change  in  size. 

Symptomatic      cure 
and  much  reduction 
in  size. 

d 

1 

a 

3 

< 

H 
K 
Eh 

Q  « 

§« 

m 

Intra-uterine,         -\-, 
100  on  eight  occa- 
sions. 

+ 

a 
'E 
-S    . 

a  o 

Is 

Vag.,  +,  50  to  150. 

^2 

aT  u 
a  o 

Is 

2  to 

■  -"^  a 

to 

IS 
o 

Eh 
Oh 
f^ 

T. 

hJ 
-< 
o 

ia 
3 

Mens,  twice  a  month 
with  constant  pain. 

Hemorrhagic  periods 
and     very     profuse 
muco-purulent  leu- 
corrhea. 

Several     attacks    of 
peritonitis  and  con- 
stant pain. 

1» 

''I 
ft 

Is 
li 

Description  of 
Growth. 

Multinodular        ab- 
dominal   tumor    of 
large  size,  2;\  inches 
above  navel. 

Symmetric     alxlom- 
inal    tumor    •>   inch 
above   navel.     Cav- 
ity very  narrow. 

Large  mass   of   firm 
texture    and    irreg- 
ular shape  posterior 
to    uterus,     appar- 
ently connected. 

Very  large  abdominal 
ti\mor — waist,     36.^ 
inches       circumfer- 
ence— e  X  t  e  n  d  i  n  g 
13.y     inches    above 
pubes. 

Known 
Dura- 
tion OF 

G  ROWTH. 

5  years. 

Un- 
certain. 

10  years. 

•xwaiivj  Ao  aoy        § 

i         ^                            1          ^ 

^ 

5g 

22  O 

Dr.  R.  H. 
Hamill,  Phil- 
adelphia. 

Howard  Hos- 
pital. 

Howard  Hos- 
pital. 

Howard  Hos- 
pital. 

asvo  JO  "Oij 

1      S 

1     5S 

1      M 

00 

1  s 

APPENDIX    A. 


381 


Eesults  unknown. 

a3 

T— 1 

Symptomatic        im- 
provement.          No 
change  in  size. 

Symptomatic       cure 
and     reduction     of 
tumor  to  1  inch  be- 
loAV  navel. 

+ 

aT 

'u 
<o 
-t^     . 

a  o 

a  -»3 

Intra-uterine,        +, 
100  ;      later      zinc- 
amalgam     catapho- 
resis,  75. 

Intra-uterine,  +,125 
ma.  ;   flexible   elec- 
trode. 

Hemorrhage         and 
pressure  symptoms. 

Profuse  hemorrhages, 
and  attacks  of  peri- 
tonitis.   Health  im- 
paired. 

Cramp-like    pain   in 
abdomen. 

Large         abdominal 
tumor  extending  31 
inches  above  navel. 

Interstitial        pelvic 
tumor,  size  of  cocoa- 
nut,  firmly  fixed. 

Multinodular        ab- 
dominal tumor  ex- 
tending 1  inch  above 
navel. 

>> 

2 
ci 

CO 

1 

O 

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CO                           1         '^ 

! 

-Hi 
o 

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pital. 

S 

85 

g 

APPENDIX  B. 


TABLE  OF  THIRTY-FOUR  CONSECUTIVE  CASES  OF  CATARRHAL 
DISEASE  OF  UTERUS  UNDER   ELECTRIC 
TREATMENT. 


(383) 


384  DISEASES    OF    WOMEN. 

Table  of  Thikty-foub  Consecutive  Cases  of  Catakbhal 


No. 

OF 

Case. 


8  23 


36 

27 

28 

32 

27 

25 

25 
37 

22 
31 

SO 
21 

25 


Ddration        Depth  of 
OF  Cavity, 

Disease.  Inches. 


8    years 
8   years 

8  years 
4    years 

2  years 

3  years 
7    years 

16   inos. 
6    years 

9  years 
3   years 

18    mos. 


1.5  years  3}^ 

1  year  3^ 

2  years       |  3 
8  years 

2  years 
1  year 

3  years 


3>.i  later  2}4 
3  to  2]^ 

3 


Mobility. 


Fixed 

Movable 

Movable 
Fixed 
M  ovable 
Movable 
Moval)le 


3    years       l    3J4  later  2>^     [Movable 
y   years  3  1  Movable 

3  i  Adherent 


Movable 


3+  later  2H       Movable 


2}4 

254 
not  sounded 


.Adherent  to  left 


Movable 


Movable 
Fixed 


3V^  to  2J4      I  Movable 
4  to  ly^  Movable 

3  Movable 

Wx  to  2%         Movable 

i 
3  Movable 


Discharges. 


Slight  niuco-pus 

Hemorrhagic  leucor. 

Hemorrhage,  leucor. 
Profuse,  purulent 
Profuse,  purulent 
Inconstant  mucoid 
Inconstant  mucoid 
Constant  muco-pus 
None  at  present 
Copious  purulent 

Copious  mucoid 

Slight  inconstant 
Inconstant 

Profuse  muco-pus 

Profuse 
Copious  purulent 

Copious  mucoid 
Moderate  mucoid 

Copious  muco-pus 
Mucoid 

Slight  mucoid 


APPENDIX    B.  385 

Disease  of  Uterus  Uxuek  Electric  Treatment. 


Condition  of 

Utekus. 


Moderately  hyper- 
trophied  " 


Corporeal      hyper- 
trophy 


Sliglit  enlarge- 

ment 

Corporeal      hyper- 
trophy 

Normal  size 
Some  enlargement 
Hypertrophied 
Hypertrophied 
Moderate  hyper. 


Hypertrophied 
with  large  cavity 


Corpus  2  inches  in 
diameter,  cavity 
large 

Capacious  cavity 
Moderate  hyper. 

Slight  hyper. 

Slight  hyper. 
Hyperplasia 

Engorged 
Hyperplasia 

Slight  hyper. 


Prolapsed    uterus, 
with  hyper. 


Hyperplasia 


Complications. 


Left  salpingitis; 
deep  laceration  of 
cervix 

Deep  stellate  lacer- 
ation of  cervix 


Retroversion        and 
stenosis 

Monolateral       lacer- 
ation 

Severe  menorrhalgia 
Severe  menori  halgia 


First  degree  of  pro- 
lapse 

Tenderness     in    left 
ovarian  region 

Menorrhalgia 


A  lacerated  cervix 
had  been  repaired 
without  relief 

A  lacerated  cervix 
had  been  repaired 
without  relief 

Tender  and  enlarged 
ovary 


Menorrhalfria 


Menorrhalgia 

Dense  masses  in 
region  of  both 
broad  ligaments 

Nervous  prostration 


Evidences  of  old  pel- 
vic inllam. 


Left  ovary  prolapsed 
Nervous  prost. 


Mode  of  Treat- 
ment. 


Results. 


—  vag.   followed   by  — 
intra-uterine,  15 


-|-  intra-uterine  flex. 
elect.  30  and  vaginal 
galv. 

-f-  intra-uterine,  25 
(twice  only) 

-|-  intra-uterine,  25  to 
65,  with  flexible  elect. 

+  and  —  intra-uterine, 
8  to  26,  and  vag.  galv. 

-I-  intra-uterine,  50  to 
■10 

+  intra-uterine,  70,  and 
prim,  farad. 

—  intra-uterine,  10  to 
25,  and  -f-  vag.,  70 

+  intra-uterine,  15  to 
25,  and  vag.  galv. 

+  intra-uterine,  35,  and 
gen.  galv. 


—  intra-uterine,  20  to 
35,  and  —  vag. 


+  intra-uterine,  20  to 
35,  and  —  vag.  galv. 

—  vag.,  60,  and  farad, 
and  +  intra-uterine, 
20 

4-  intra-uterine,  once 
only 

+  intra-uterine,  20 

-f  vag.,  100  to  150 


-f  intra-uterine.  20  to 
25,  and  vag.  galv. 

intra-uterine  alterna- 
tives, 70,  and  vag. 
galv. 

+  intra-uterine,  20,  and 
vag.  galv. 

+  intra-uterine,  flex, 
elect..  25  to  40,  and 
vag.  gal. 

—  intra-uterine,  20,  and 
vag.  galv. 


Cure,  followed  by  preg- 
nancy 


Improved 


Cure,      followed      by 
pregnancy 

Improved,  followed  by 
pregnancy 

Cured 


Cure  d,    followed   by 
two  pregnancies 

Cure,    with    improve- 
ment of  prolapse 

Cured 


Cured 
Cured 


Improved 


Cured 


Symptomatic  cure,  ad- 
hesions remain 


Cured,     followed     by 
pregnancy 

Cured 

Symptomatic  cure,  ad- 
hesions loosened 


Cured 


Cured,     followed     by 
pregnancy 


Improved 


Cuied, 
low 


Improved 


still 


386  DISEASES    OF    WOMEN. 

Table  of  Thirty-four  Coxsecctive  Cases  of  Catarrhal 


No. 

OF 

Case. 

Age. 

Duration 

OP 

Disease. 

Depth  of 
Cavity. 
Inches. 

Mobility. 

Discharges. 

22 

29 

7   years 

3 

Movable 

Profuse  muco-i>ur. 
hemorrhagic 

23 

24 

7   years 

3 

Movable 

Copious  mucoid 

24 

24 

3   years 

2)^ 

Movable 

Copious  purulent 

25 

22 

4    years 

3 

Movable 

Constant  mucoid 

26 

26 

6   years 

3+ 

Adherent 

Profuse  offensive 
muco-pus 

27 

26 

4   years 

3 

Movable 

Profuse  muco-pus 

28 

31 

3   years 

3 

Movable 

Profuse  muco-pus 

29 

26 

4   years 

2^i 

Adherent 

Profuse  purulent 

30 

40 

2   years 

3,  later  2}4 

Movable 

Hemorrhage,  leucor. 

31 

30 

3   years 

3H 

Movable 

Mucoid 

.S2 

30 

1    year 

3 

Fixed 

Muco-pus 

33 

34 

1    year 

3,  later  2i^ 

Movable 

Muco-pus 

34 

38 

5   years 

3J4 

Slightly  adherent 

Muco-pus 

APPENDIX   B.  387 

Disease  of  Uterus  Under  Electric  Treatment  [concluded). 


Condition  of 
Uterus. 

Complications. 

Mode  of  Treat- 
ment. 

Re.sults. 

Stenosis,  cervix 

Menorrhalgia 

+   intra-uterine,  20  to 
50 

Cured 

Nervous  prost. 

+  intrauterine,  25,  and 
vag.  galv. 

-|-Intra-uterine,      flex, 
elect.,  20   to  80,    and 
vag.  gal. 

Improved 

Cured,  followed  by 
pregnancy 

Moderate  liyper. 

+  intra-uterine,  20  to 
35 

Cured 

Hyperplasia 

Prolapse      of 
ovaries      and 
largemeut    of 
ovary 

both 
en- 
left 

-f  and  —  intra-uterine, 
20  to  30,  and  secondary 
faradic 

Discharge  cured  and 
enlargement  lessened 

Tenderness    in 
rian  regions 

ova- 

+  intra-uterine,  50 

Cured 

Hyperplasia 

—  intra-uterine,  50 

Improved 

Tubes  involved 

—  intra-uterine,  50,  and 
vag.  galv. 

Cured 

Hyperplasia 

-f  intra-uterine,  .50 

Cured,  followed  by 
pregnancy 

Tenderness 
thickening   at 
broad  lig. 

and 
left 

—  intra-uterine,  15  to 
40  and  neg.  vag. 

Cured 

Tenderness 
thickening  at 
broad  lig. 

anfl 
both 

—  intra-uterine,  35.  pre- 
ceded by  —  vag..  50 

Symptomatic  cure 

Hyperplasia      and 
prolapsed 

—  and  +  intra-uterine, 
50  to  75 

Improved 

Hyperplasia       and 
prolapsed 

+   intra-ntevine,  25  to 
50  (for  two  months) 

Greatly  improved. 
Two  years  later  hys- 
terectomy for  sup- 
posed cancer,  with 
fatal  results 

INDEX. 


Abdominal  puncture,  138 

relaxation,  15 
Abdomino-dorsal  applications,  55 
Abortion,  227 
Absorbent  cotton,  31 

pads,  309 
Acid  carbon  cell,  351 
Adams,  Prof.  W.  G.,  33 
Adams,  Wellington,  306 
Adenoids  of  rectum,  272 
Alterative  action  of  electricity,  50 
Alternating  incandescent  current,  352 
Amalgamation  of  zincs,  300 
Amenorrhea,  72 
Ampere,  the,  283 
Anal  fissure,  269 
Analgesic  action,  59 
Anelectrotonus,  48 
Anions,  39 
A  nodal  diffusion,  42 
Anteversion,  187,  191 
Antisepsis,  22 

Apostoli,  G.,  17,   18,  24,  25,  32,  40,  48, 
58,    60,   63,  84,  88,  98,  114, 
127,  341 
Apostoli  bipolar  electrode,  56 

clay  pad,  309 

intra-uterine  electrode,  60 

puncture  trocar,  136 
Areolar  hyperjjlasia  of  mamma,  257 
Arrangement  of  cells,  284 


Aseptic  precautions,  22 
Aspiration,  20 
Atony  of  bladder,  259 
Atresia  of  cervical  canal,  212 

Bactericidal  action  of  electricity,  48 
Balrd,  W.  T.,  228 
Battery  fluid,  303 
Beard,  George  M.,  204 
Benign  tumors  of  breast,  256 
Bimanual  abdominal  examinations,  14 

touch,  16 
Bipolar  applications,  58 
Bladder,  atony  of,  259 
Border-line    between    gynecology    and 

neurology,  197 
Brothers,  A.,  220 
Buckmaster,  A.  H.,  62 

Campbell,  H.  F.,  67 
Cancer,  231 

author's  method,  236,  239 

Parsons's  method,  233 
Carbon  cylinder  cell,  297 
Care  of  portable  batteries,  301 
Caruncle,  258 
Cataphoresis,  42 
Cataphoric  speed  of  atoms,  46 
Catarrhal  affections,  86 
Catelectrotonus,  48 
Cations,  39 

(389) 


390 


INDEX. 


Cautery  controller,  358 
Cells,  portable,  297 

stationary,  295 
Cervical  endometritis,  91 
Cheniic  effects  of  electricity,  40 
Choice  of  pole,  50 
Chronic  metritis,  95 
Clay  pad,  Apostoli,  309 
Cleaves,  M.  J.,  44 
Cohnheim's  hj-pothesis,  121 
Combiner,  327 

Commutator  (pole-changer),  327 
Contra-indications   to  intra-iiterine   ap- 
plications, 65 
Controllers,  current-,  303 
Corporeal  endometritis,  95 
Cosmetic  applications  of  electricity,  273 
Coulomb,  the,  283 
Cozzolino,  .356 
Current-  concentration,  35 

controllei-s,  303 

diffusion,  32 
Cystoscopic  syringe,  265 
Cystoscopy,  260 

D'Arsonval,  Professor,  326,  349 
De  Watteville  combiner,  327 
Differences  between  currents,  51 
Direct  curreut,  277 
Direct  organic  stimulation,  48 
Direction  of  current  in  cell,  280 
Diseases  of  rectum,  269 
Displacements,  183 
Dolbear,  Prof.  A.  E.,  25 
Dorsal  position,  15 
Duration  of  application,  64 
Dysmenorrhea  (menorrhalgia),  74 

Ectopic  gestation,  215 
Edison  current,  290 


Electric-light  bath,  359 
Electricity  as  a  remedj',  24 
Electrode  asejjsis,  22 

coverings,  31 
Electrodes,  308 
Electrolysis,  38 
Electromotive  force,  277 
Electro-puncture,  abdcnninal,  138 

vaginal.  136 
Electrotherm,  the.  360 
Endometritis,  91 

cervical,  91 

corporeal,  95 
Engelmann  coils,  325 

faradic  battery,  325 
Environment,  influence  of,  1 
Epithelioma,  233,  253 
Erb.  Professor,  25,  33 
Examination  of  cases,  9 
Excitation  of  function,  46 
Experiments  with  currents,  312 
Extra  curreut,  320 
Extra-uterine  pregnancy,  215 

Faithfull,  Mrs.  Edith,  232 
Faradic  currents,  318 
■  Fibroid  tumors,  121 

clinical  varieties,  123 

contra-indications,  134 

methods  of  application,  135 

mode  of  action  of  electricity,  131 

natural  prognosis,  127 

origin,  121 

results  of  treatment,  141 

selection  of  ca.ses,  133 
Fissure  of  anus,  269 
Flemming  No.  4  faratlic  battery,  322 

portable  l)attery,  299 
Fluid  for  battery,  303 
Fox,  George  H.,  273 


INDEX. 


391 


Franklinic  electricity, '332 
induced  currents,  340 
Functional  incapacity  of  the  abdominal 
walls,  194 

Gaifle  battery,  228 
Galvanic  current,  277 
Galvano-cheniic  caiiterization,  59 
Gautier,  G.,  44 
Geiger  shunt  controller,  293 
General  faradic  stimulation,  55 
General  galvanic  stimulation,  53 
General  practitioner  and  electricity,  28 
Goelet,  A.  H.,  44,  57,  59,  102,  103,  109 
Goelet's  bipolar  vaginal  electrode,  59 

faradic  coils,  325 
Goodell,  William,  53,  202 
Grand  and  Famarque,  161 
Granular  erosion,  92 

Harda^vay,  W.  A.,  273 
Haultain,  F.  W.  X.,  172 
Hayes,  Plym.  S.,  273 
Head-spray,  339 
Hematosalpinx,  111 
Hemorrhagic  metritis,  99 
Hemorrhoids,  269 
Heredity,  2 

Hollow,  bulbous  electrode,  242 
Holtz  machine,  335 
Hydrosalpinx,  111 
Hydrothermal  applications,  68 
Hyperemesis  gravidarum,  227 
Hyperplasia  of  uterus,  100 
Hypertrophy  of  cervix,  188 

Illumination  of  vagina,  20,  353 
Impotence,  212 

Improved  IMassey  controller,  292 
Incandescent  current,  290 


Indii'ect  stimulation,  46 
Inertia  uteri,  229 
Institutional  treatment,  209 
Internal  resistance,  284 
Interpolar  region,  37 
Interrupted  galvanic  cuiTcnts,  51 
Interrujrter  (rheotome),  329 
Intra-uteriue  applications,  59 

faradic  applications,  66 
Isaac's  search-light,  354 

Jacketed  pan  for  clay  pads,  308 

Jackson,  Chevalier,  357 

Jackson's  transilluminating  apparatus, 

357 
Jewell  current-controller,  294 

Keith,  Skene,  129 
Keith,  Thomas,  129,  161 
Kellogg,  J.  H.,  161,  349,  360 
Kellogg's  electric-light  bath,  359 

sinusoidal  apparatus,  346 
Kelly's  cystoscope,  262 

ureteral  searcher,  266 

urethral  calibrator,  263 

urethral  dilator,  264 
Kelvin,  Lord  332 

Kennelly  sinusoidal  apparatus,  350 
Knee-chest  position,  67 

Labor,  faradic  current  in,  228 
Laceration  of  cervix,  100 
Law  of  Ohm,  283 
Leclanche  cell,  296 
Limitations  of  electricity,  29 
Local  action,  300 

Malignant  growths,  231 
Mammary  tumors,  benign,  256 
Martin,  F.  H.,  62 


392 


INDEX. 


Massage,  70 

Massey  abdominal  puncture  needle,  139 
cancer  electrcxles.  241 
current-controller,  294,  305 
double,  bipolar  electrode,  254 
hemorrhoidal  electrode,  270 
improved  static  machine,  334 
intra-uterine  electrode,  61 
method  of  treating  cancer.  239 
pelvic  transilluniinator,  356 
spiral  intra-uterine  electrode,  62 
switchboard,  292 

for  both  currents,  310 
transportable  galvanic  battery,  238 
vaginal  puncture  tiocar,  136 
wired-cotton  pads,  309 

Maternal  imjxttence,  212 
sterility,  212 

Mcintosh  farad  ic  batterj-,  323 
galvanic  battery,  301 
sinusoidal  apparatus,  349 
switchboard,  296 

Measurement  of  tumors,  14 
of  voltage,  307 

Medicaniental  cataphoresis,  45 

Menorrhagia,  83 

Menorrhalgia,  74 
ners-ous,  77 
ovarian,  82 
uterine,  78 

Menorrhspasm.  76 

Menstrual  derangements,  72 

Mercuric  cataphoresis,  44 

Metallic  cataphoresis,  43 

Meters,  milliampere-,  306 

Metritis,  chronic,  95 
hemorrhagic,  99 
post^puerperal,  98 
senile,  102 


Metrorrhagia,  83 
Metrosalpingitis,  103 
Jlilliampere,  the.  283 
Milliamp'-remeters,  306 
Millicoulomb,  the,  283 
Mitchell,  S.  Weir,  71,  201 
Moles,  275 

Morton,  William  James,  44,  332,  340 
Morton's  induced  current,  340 

Nabothian  glands,  92 
Nervous  menorrhalgia,  77 

prostration,  204 
Neurasthenia.  204 
Neuroses  of  the  urethra,  259 

of  the  vulva,  259 
Nevus  pigmentosus,  276 

vasculosus,  275 
Newman,  Robert,  232 
Normal  formula  of  motor  responses,  48 
Nunn,  R.  J.,  228 

Obstetrics,  215 
Ohm,  law  of,  283 
Ovarian  congestion,  119 

menorrhalgia,  82 
Ovaritis,  chronic,  114 
Ozone  administration,  341 

Parsons,  J.  Inglis-,  233 
Pelvic  peritonitis,  112 
Persistent  uterine  discharges,  90 
Pessaries,  70 
Peterson,  Frederick,  42 
Phillips,  W.  C,  354,  355 
Phillips's  head-light,  .355 
Polar  regions,  36 
Polarity  of  fara<lic  current,  328 
Polarity  test,  312 
Pole-changer  (commutator)  327 


INDEX. 


393 


Portable  batteries,  297 
Port-wiue  mark,  275 
Post-partum  hemorrhage,  229 
Post-puerpeial  metritis,  98 
Posture  in  treatment,  67 
Predisposing  causes,  1 
Pressure  (electromotive  force),  277 
Primary  coils,  322 

faradic  current,  323 
Prolapse  of  rectum,  270 

of  uterus,  187 
Purulent  salpingitis,  106 
Pj'osalpinx,  107 

Queen  self-regulating  x-ray  tube,  343 

Kectal  touch,  19 
Rectum,  adenoids  of,  272 

fissure  of,  269 

prolapse  of,  270 

stricture  of,  271 

ulcerations  of,  272 
Relaxation  of  abdominal  walls,  194 

of  pelvic  viscera,  183 
Resistance,  281 
Rest  cure,  the,  201 
Retroflexion,  183,  192 
Retroversion,  183,  193 
Rheotome  (current-interrupter),  326 
Roentgen  rays,  342 

Sajous's  lamp-holder,  353 
Salpingitis,  106 
Salt  water  on  electrodes,  314 
Sarcoma,  cataphoric  treatment  of,  252 
Scanty  menstruation,  73 
Secondary  coils,  324 

faradic  currents,  324 
Series  arrangement  of  sells,  295 


.Shaw  acid  carbon  cell,  351 

carbon  cylinder  cell,  297 
Shunt  circuit,  285 
Sinis's  position,  19 

speculum,  20 
Sinusoidal  current,  346 
Skene,  A.  J.  C,  68,  91,  102,  119 
Skin  resistance,  316 
Slocum,  H.  A.,  260 
Smith,  A.  Lapthorn,  28,  161 
Specific  resistance,  282 
Spinal  applications,  55 
Stabile  (stationary)  applications,  56 
Static  charge,  338 

electricity,  332 

electrodes,  337 

in  menstrual  affections,  342 

machine,  333 

sparks,  339 

spray,  339 
Stationary  battery,  295 
Stenosis,  212 
Sterility,  212 
Storage  battery,  355 
Strength  of  application,  64 
Stricture  of  rectum,  271 

of  urethra,  258 
Subinvolution,  98,  230 
Superfluous  hair,  273 
Switchboards,  311 

Tait,  Lawson,  215 
Tampons,  69 
Test  for  current,  312 
for  polarity,  312 
Transformer  for  alternating  cuiTents,  358 
Transillumination  of  pelvis,  356 
Transportable  battery,  238 
Tripier,  A.,  24,  40,  58,  189,  228 


394 


INDEX. 


Ulceration  of  rectum,  272 

Units  of  current,  283 

Unity  of  uterine  and  tubal  catarrh,  86 

Urethra,  neuroses  of,  259 

strictures  of,  258 
Uterine  menorrhalgia,  78 

sound,  17 

Vaginal  applications,  56,  58 

douche,  68 

puncture,  136 
Volt,  the,  280 
Voltolini,  356 


Volume  of  current,  283 
Vulva,  neuroses  of,  259 

Waite  &  Bartlett  battery,  304 
Warts,  275 

Westinghouse  current,  229,  290,  352 
Weston  milliameter,  307 
Wheel  interrupter,  327 
Wimshurst-Holtz  machine,  335 
Wired-cotton  electrode  pads,  309 
Wylie,  W.  Gill,  75 

X-rays  from  static  machine,  312 

Zinc-amalgam  electrodes,  63 


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